中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
3期
4-7
,共4页
连续气道正压通气%心力衰竭%睡眠呼吸暂停,阻塞性%高血压性心脏病
連續氣道正壓通氣%心力衰竭%睡眠呼吸暫停,阻塞性%高血壓性心髒病
련속기도정압통기%심력쇠갈%수면호흡잠정,조새성%고혈압성심장병
Continuous positive airway pressure%Heart failure%Sleep apnea,obstructive%Hypertensive heart disease
目的 探讨经鼻持续气道内正压(nCPAP)治疗高血压性心脏病慢性心力衰竭(CHF)伴重度阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者的临床疗效.方法 选择高血压性心脏病CHF伴重度OSAHS患者50例.按随机数字表法分为治疗组和对照组.治疗组25例接受nCPAP及常规药物治疗,对照组25例只接受常规药物治疗,均治疗3个月.比较两组治疗前后心功能分级、血压、左心室舒张末期内径(LVDd)、左心室射血分数(LVEF)、脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)的变化.结果 治疗组的有效率明显高于对照组[76.00％(19/25)比40.00％(10/25)],差异有统计学意义(P＜0.05).两组治疗后血压均显著下降[治疗组:(127.52±10.38)/ (72.44±4.92) mmHg(1mmHg =0.133 kPa)比(176.80±12.90)/(100.44±5.55) mmHg;对照组:(150.12±18.96)/(81.64±9.42) mmHg比(176.00±11.69)/(96.08±18.59) mmHg],且治疗组治疗后血压下降更明显,差异均有统计学意义(P＜ 0.01或＜0.05).治疗组治疗后LVDd、BNP、hs-CRP较治疗前显著下降[(49.12±3.18) mm比(57.44±3.62) mm、525.52 ng/L比785.25 ng/L、(7.76±1.69) mg/L比(18.04±2.58) mg/L]; LVEF显著升高[(46.12±2.52)％比(38.68±4.65)％],差异均有统计学意义(P＜0.01).对照组治疗后LVDd、LVEF与治疗前比较差异无统计学意义(P＞0.05),BNP、hs-CRP与治疗前比较显著下降[668.66 ng/L比850.96 ng/L、(12.88±2.02) mg/L比(19.40±2.30) mg/L],但下降幅度低于治疗组,差异均有统计学意义(P＜ 0.05或＜0.01).结论 对于高血压性心脏病CHF伴重度OSAHS患者,nCPAP能有效改善心力衰竭症状,降低血压,改善心功能,减轻炎性反应.
目的 探討經鼻持續氣道內正壓(nCPAP)治療高血壓性心髒病慢性心力衰竭(CHF)伴重度阻塞型睡眠呼吸暫停低通氣綜閤徵(OSAHS)患者的臨床療效.方法 選擇高血壓性心髒病CHF伴重度OSAHS患者50例.按隨機數字錶法分為治療組和對照組.治療組25例接受nCPAP及常規藥物治療,對照組25例隻接受常規藥物治療,均治療3箇月.比較兩組治療前後心功能分級、血壓、左心室舒張末期內徑(LVDd)、左心室射血分數(LVEF)、腦鈉肽(BNP)、高敏C反應蛋白(hs-CRP)的變化.結果 治療組的有效率明顯高于對照組[76.00％(19/25)比40.00％(10/25)],差異有統計學意義(P＜0.05).兩組治療後血壓均顯著下降[治療組:(127.52±10.38)/ (72.44±4.92) mmHg(1mmHg =0.133 kPa)比(176.80±12.90)/(100.44±5.55) mmHg;對照組:(150.12±18.96)/(81.64±9.42) mmHg比(176.00±11.69)/(96.08±18.59) mmHg],且治療組治療後血壓下降更明顯,差異均有統計學意義(P＜ 0.01或＜0.05).治療組治療後LVDd、BNP、hs-CRP較治療前顯著下降[(49.12±3.18) mm比(57.44±3.62) mm、525.52 ng/L比785.25 ng/L、(7.76±1.69) mg/L比(18.04±2.58) mg/L]; LVEF顯著升高[(46.12±2.52)％比(38.68±4.65)％],差異均有統計學意義(P＜0.01).對照組治療後LVDd、LVEF與治療前比較差異無統計學意義(P＞0.05),BNP、hs-CRP與治療前比較顯著下降[668.66 ng/L比850.96 ng/L、(12.88±2.02) mg/L比(19.40±2.30) mg/L],但下降幅度低于治療組,差異均有統計學意義(P＜ 0.05或＜0.01).結論 對于高血壓性心髒病CHF伴重度OSAHS患者,nCPAP能有效改善心力衰竭癥狀,降低血壓,改善心功能,減輕炎性反應.
목적 탐토경비지속기도내정압(nCPAP)치료고혈압성심장병만성심력쇠갈(CHF)반중도조새형수면호흡잠정저통기종합정(OSAHS)환자적림상료효.방법 선택고혈압성심장병CHF반중도OSAHS환자50례.안수궤수자표법분위치료조화대조조.치료조25례접수nCPAP급상규약물치료,대조조25례지접수상규약물치료,균치료3개월.비교량조치료전후심공능분급、혈압、좌심실서장말기내경(LVDd)、좌심실사혈분수(LVEF)、뇌납태(BNP)、고민C반응단백(hs-CRP)적변화.결과 치료조적유효솔명현고우대조조[76.00％(19/25)비40.00％(10/25)],차이유통계학의의(P＜0.05).량조치료후혈압균현저하강[치료조:(127.52±10.38)/ (72.44±4.92) mmHg(1mmHg =0.133 kPa)비(176.80±12.90)/(100.44±5.55) mmHg;대조조:(150.12±18.96)/(81.64±9.42) mmHg비(176.00±11.69)/(96.08±18.59) mmHg],차치료조치료후혈압하강경명현,차이균유통계학의의(P＜ 0.01혹＜0.05).치료조치료후LVDd、BNP、hs-CRP교치료전현저하강[(49.12±3.18) mm비(57.44±3.62) mm、525.52 ng/L비785.25 ng/L、(7.76±1.69) mg/L비(18.04±2.58) mg/L]; LVEF현저승고[(46.12±2.52)％비(38.68±4.65)％],차이균유통계학의의(P＜0.01).대조조치료후LVDd、LVEF여치료전비교차이무통계학의의(P＞0.05),BNP、hs-CRP여치료전비교현저하강[668.66 ng/L비850.96 ng/L、(12.88±2.02) mg/L비(19.40±2.30) mg/L],단하강폭도저우치료조,차이균유통계학의의(P＜ 0.05혹＜0.01).결론 대우고혈압성심장병CHF반중도OSAHS환자,nCPAP능유효개선심력쇠갈증상,강저혈압,개선심공능,감경염성반응.
Objective To investigate the clinical efficiency of nasal continuous positive airway pressure (nCPAP) on patients with chronic heart failure(CHF) due to hypertensive heart disease complicated with severe obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Fifty cases with CHF due to hypertensive heart disease complicated with severe OSAHS were divided into treatment group and control group with 25 cases each by the method of random digits table.nCPAP and routine drug treatment were administered in treatment group,while only routine drug treatment was given in control group.Cardiac functional grading,blood pressure,left ventricular end diastolic dimension (LVDd),left ventricular ejection fraction (LVEF),B-type natriuretic peptide (BNP),high-sensitivity C-reactive protein (hs-CRP) were compared before and after 3-month therapy.Results The effective rate in treatment group was significantly higher than that in control group [76.00％(19/25) vs.40.00％(10/25)],and there was significant difference (P ＜0.05).There was significantly decreased in blood pressure in two groups at the end of the therapy [treatment group:(127.52 ± 10.38)/(72.44 ±4.92) mmHg(1 mmHg =0.133 kPa) vs.(176.80 ± 12.90)/ (100.44 ±5.55) mmHg;control group:(150.12 ± 18.96)/ (81.64 ±9.42) mmHg vs.(176.00 ± 11.69)/ (96.08 ± 18.59) mmHg] (P ＜ 0.01),but the blood pressure was significantly lower in treatment group than that in control group (P ＜0.05).LVDd,BNP and hs-CRP in treatment group was declined significantly [(49.12 ± 3.18) mm vs.(57.44 ± 3.62) mm,525.52 ng/L vs.785.25 ng/L,(7.76 ± 1.69) mg/L vs.(18.04 ± 2.58) mg/L](P＜ 0.01);LVEF was significantly increased [(46.12 ± 2.52)％ vs.(38.68 ± 4.65)％](P＜ 0.01).There was no significant difference in LVDd and LVEF in control group before and after therapy (P ＞ 0.05).BNP and hs-CRP also were declined significantly [668.66 ng/L vs.850.96 ng/L,(12.88 ± 2.02) mg/L vs.(19.40 ± 2.30) mg/L] (P ＜ 0.05 or ＜ 0.01),but the above two were significantly lower in treatment group than those in control group(P ＜ 0.05).Conclusion nCPAP therapy can effectively improve the symptoms of heart failure,decrease blood pressure,improve cardiac function,reduce the inflammation response to patients with CHF due to hypertensive heart disease complicated with severe OSAHS.
