CAJ | 학술논문

目的探讨慢性间歇低氧对OSAHS患者左心功能的影响,以及持续气道正压通气(CPAP)治疗后左心功能和血压的变化.方法顺序收集2007年5月至2008年12月于吉林大学第一医院就诊的、符合OSAHS诊断标准的门诊或住院患者75例(OSA组),其中非高血压者35例,合并高血压者40例.另选30名健康人为对照组,其中男20名,女10名,年龄30～65岁,与患者组年龄匹配,均为经系统检查无异常发现的健康人.对两组左心室射血分数(left ventricular ejection fraction,LVEF)、短轴缩短率(shortening fraction,FS)、E峰、A峰,并计算E/A进行比较.CPAP治疗后的血压、LVEF、E/A进行分析.结果所有患者晨起血压(150.80±20.73/108.0±15.34)mm Hg(1 mm Hg=0.133 kPa)均较睡前血压(134.16±18.33/90.09±11.24)mm Hg明显升高.OSA组E/A明显降低(P<0.01),LVEF、FS明显降低(P<0.05);与对照组及OSA非高血压组比较,OSA合并高血压的患者左室射血分数和短轴缩短率均减少,提示高血压的出现是OSA左室收缩功能减退的重要因素;与对照组比较,OSA非高血压组E/A明显降低;非高血压组和高血压组比较,高血压组E/A下降显著,说明OSA本身可直接影响左心室舒张功能,而高血压的出现加重了左心室的舒张功能的降低.经CPAP治疗6个月后晨起血压(142.59±15.34/96.52±9.81)mmHg较治疗前(150.80±20.73/108.0±15.34) mm Hg显著下降(P<0.001);左室射血分数(59.70±11.1)%较治疗前(56.40±9.74)%增加(P<0.05);E/A值1.16±0.25较治疗前0.87±0.17明显增加(P<0.01).结论 (1)CIH可引起左心结构和功能发生改变,高血压的出现加重了这种变化.(2)CPAP对于纠正OSA患者高血压、改善左心功能,提高生活质量有重要意义.
목적 탐토만성간헐저양대OSAHS환자좌심공능적영향,이급지속기도정압통기(CPAP)치료후좌심공능화혈압적변화.방법 순서수집2007년5월지2008년12월우길림대학제일의원취진적、부합OSAHS진단표준적문진혹주원환자75례(OSA조),기중비고혈압자35례,합병고혈압자40례.령선30명건강인위대조조,기중남20명,녀10명,년령30～65세,여환자조년령필배,균위경계통검사무이상발현적건강인.대량조좌심실사혈분수(left ventricular ejection fraction,LVEF)、단축축단솔(shortening fraction,FS)、E봉、A봉,병계산E/A진행비교.CPAP치료후적혈압、LVEF、E/A진행분석.결과 소유환자신기혈압(150.80±20.73/108.0±15.34)mm Hg(1 mm Hg=0.133 kPa)균교수전혈압(134.16±18.33/90.09±11.24)mm Hg명현승고.OSA조E/A명현강저(P<0.01),LVEF、FS명현강저(P<0.05);여대조조급OSA비고혈압조비교,OSA합병고혈압적환자좌실사혈분수화단축축단솔균감소,제시고혈압적출현시OSA좌실수축공능감퇴적중요인소;여대조조비교,OSA비고혈압조E/A명현강저;비고혈압조화고혈압조비교,고혈압조E/A하강현저,설명OSA본신가직접영향좌심실서장공능,이고혈압적출현가중료좌심실적서장공능적강저.경CPAP치료6개월후신기혈압(142.59±15.34/96.52±9.81)mmHg교치료전(150.80±20.73/108.0±15.34) mm Hg현저하강(P<0.001);좌실사혈분수(59.70±11.1)%교치료전(56.40±9.74)%증가(P<0.05);E/A치1.16±0.25교치료전0.87±0.17명현증가(P<0.01).결론 (1)CIH가인기좌심결구화공능발생개변,고혈압적출현가중료저충변화.(2)CPAP대우규정OSA환자고혈압、개선좌심공능,제고생활질량유중요의의.
Objective To investigate the influence of left heart function in obstructive sleep apnea by CIH, and explore left heart function and blood pressures before or after CPAP. Methods 75 OSA were divided into two groups :40 patients blood pressures were coincident with diagnostic standard of hypertension recording;35 patients blood pressures were non-hypertension recording. The control group included 30.healthy adults. The blood pressures before and also after sleep, left ventricular ejection fraction (LVEF),shortening fraction(FS), E, A and E/A were compared with those of normal control subjects. Analyzed BP,LVEF and E/A after CPAP. Results (1)The blood pressure soon after getting up in the morning(150.80±20.73/108.0±15.34) mm Hg(1 mm Hg = 0.133 kPa) was significantly higher than that before sleep (134.16±18.33/90.09±11.24) mm Hg(P < 0.001 ). (2)Multiple parameters including LVEF, FS and E/A, were impaired in OSA patients relative to the control subjects(P <0.05 or P <0.01), OSA affected cardiovascular function directly; E/A was significantly decreased in obstructive sleep apnea unallied hypertension than that in normal control subjects; E/A was conspicuously decreased in obstructive sleep apnea associated hypertension comparing with that in obstructive sleep apnea unallied hypertension. These showed OSA affected cardiovascular function directly, hypertension aggravated the drop in cardiovascular function. 3. After CPAP in 6 months, it (142.59±15.34/96.52±9.81) mm Hg was significantly decreased than that before treatment(150.80±20.73/108.0±15.34) (P < 0. 001 ) ; LVEF (59.70±11.1)% was increased than that before treatment (56.40±9.74)% (P <0. 05) and E/A 1.16 ±0.25 was increased. Than that before treatment 0.87±0.17(P<0.01). Conclusion (1)CIH may affect left heart structure and function; these changes were aggravated with hypertension. (2)CPAP treatment had important sense in the treatment of hypertension and cardiovascular function, and improved the life quality.