摘要
目的:探讨阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)对难治性高血压(resistant hypertension,RH)患者血压及左心室结构、功能的影响。方法:招募2016年1月—2017年10月因RH入住本院的鼾症患者。根据睡眠呼吸暂停低通气指数(Sleep apnea hypoventilation index,AHI)分为单纯RH患者为RH组,RH合并OSAHS轻度组,RH合并OSAHS中度组和RH合并OSAHS重度组,每组患者各30例。监测前,分别记录每组患者性别,年龄及体重指数(Body Mass Idex,BMI)。采用多导睡眠呼吸监测患者睡眠指标,动态血压监测检测患者血压指标,超声心电图监测检测患者心动图指标。应用SPSS Statistics 19(SPSS Inc.Chicago,Illinois)软件对所得数据进行统计分析。结果:四组患者间性别、年龄无明显差异(P>0.05)。随着AHI越高,患者BMI越大,且AHI、平均动脉血氧饱和度(MSaO_2)和动脉血氧饱和度<90%时间(TSaO_2L90)三个睡眠指标在各组间均有统计学意义(P<0.05)。在动态血压监测方面,不同程度OSAHS组与RH组相比,在24小时平均收缩压(24h MSP)、24小时平均舒张压(24h MSP)、日间平均收缩压(DMSP)、日间平均舒张压(DMDP)、夜间平均收缩压(NMSP)及夜间平均舒张压(NMDP)均有统计学意义(P<0.05)。OSAHS程度越高,血压升高明显,且患者夜间高血压发生率较高(P<0.05)。在左心室结构重塑指标[室间隔厚度(IVST),左室后壁厚度(LVPWT),左心室质量指数(Left ventricular mass index,LVMI)]方面,四组患者间均有统计学差异(P<0.05)。在左心室舒张功能指标[左心室舒张末内径(left ventricular internal diameter end-diastolic,LVIDd),舒张末期容积(Left ventricle end-diastolic volume,EDV)]方面,OSAHS中度组和重度组患者较RH单纯组和轻度OSAHS患者减退更明显,且重度OSAHS合并RH患者左心室舒张功能减退程度最高(P<0.05)。在左心室收缩功能指标[左心室收缩末期容积(Left ventricle endsystolic volume,ESV),左心室射血分数(Left ventricular ejection fraction,LVEF)]方面,OSAHS重度组与其他三组有明显差异(P<0.05)。结论:OSAHS合并RH患者应注意控制体重。AHI越高,患者血压越高,且随着OSAHS病情加重,患者左心室结构重塑、左心室舒张和收缩功能均产生影响。
Objective To investigate the effects of obstructive sleep apnea hypopnea syndrome(OSAHS) on blood pressure, left ventricular structure and function in patients with refractory hypertension(RH). Methods Recruitment of snoring patients admitted to our hospital from January 2016 to October 2017 due to RH. According to the sleep apnea hypoventilation index(AHI), patients with RH were divided into RH group(n=30), RH combined OSAHS mild group(n=30), RH combined OSAHS moderate group(n=30) and RH combined OSAHS severe group(n=30). Before monitoring, the gender, age and body mass index(BMI) of each group were recorded. Sleep polysomnography was used to monitor sleep parameters, ambulatory blood pressure monitoring was used to measure the patient's blood pressure, and echocardiography was used to detect the patient's cardiogram index. The data were statistically analyzed using SPSS Statistics 19(SPSS Inc. Chicago, Illinois) software. Results There was no significant difference in gender and age between the four groups(P>0.05). The higher the AHI, the greater the BMI and the AHI, mean arterial oxygen saturation(MSaO_2), and arterial oxygen saturation <90%(TSaO_2 L90) were statistically significant among the groups(P<0.05). In ambulatory blood pressure monitoring, OSAHS group and RH group had significantly difference in the aspect of 24-hour mean systolic blood pressure(24 h MSP), 24-hour mean diastolic pressure(24 h MSP), daytime mean systolic pressure(DMSP), daytime mean diastolic pressure(DMDP), nighttime mean systolic pressure(NMSP) and nighttime mean diastolic pressure(NMDP)(P<0.05). The higher the degree of OSAHS, the obvious increase of blood pressure, and the incidence of nocturnal hypertension were higher(P<0.05). The left ventricular mass index(LVMI) and left ventricular mass index(LVMI) were significantly different between the four groups in terms of(LVIDd) and left ventricle end-diastolic volume(EDV), the indexes in moderate and severe OSAHS group were significantly higher than those in RH and mild OSAHS group, and the degree of left ventricular diastolic dysfunction was the highest in severe OSAHS with RH(P <0.05). In left ventricular systolic volume [left ventricular end-systolic volume(ESV), left ventricular ejection fraction(LVEF)], OSAHS severe group was significantly different from the other three groups( P <0.05). Conclusion OSAHS patients with RH should pay attention to weight control. The higher the AHI, the higher the patient's blood pressure, and as the OSAHS progresses, the left ventricular remodeling and left ventricular diastolic and systolic functions are affected.
出处
《影像研究与医学应用》
2018年第7期248-251,共4页
Journal of Imaging Research and Medical Applications
