CAJ | 학술논문

目的探讨睡眠呼吸暂停综合征(SAS)合并心律失常患者在常规应用心血管药物基础上联合无创正压通气(NPPV)治疗的意义.方法选择多导睡眠监测(PSG)及心电图或动态心电图确诊为中、重度SAS合并心律失常患者135例,按照随机方法分为NPPV组(69例)和对照组(66例),对照组单纯行心内科常规药物治疗,NPPV组在常规药物治疗基础上加用NPPV,治疗3个月后复查相关指标.结果 (1) NPPV组治疗前后比较,ESS评分、呼吸暂停低通气指数(AHI)、微觉醒指数均明显下降,分别是8.25 ±5.41和4.08 ±3.43、39.95±7.32和4.71 ±1.80、39.69±4.40和15.20 ±2.05,P均＜0.05；Ⅲ期及快速动眼期睡眠时间明显增加最低血氧饱和度升高,分别是(4.53±2.10)％和(16.78±2.59)％、(8.37±1.380)％和(15.25±1.41)％、(77.15±6.72)％和(93.35±2.03)％,P均＜0.01.(2) NPPV组治疗前后比较,窦性心动过缓、窦性心动过速、窦性停搏、房性早搏、室性早搏、短阵性房性心动过速、短阵性室性心动过速、心房颤动、二～三度房室传导阻滞、无症状ST-T段改变发生率由57.4％、44.4％、7.4％、20.4％、13.0％、36.5％、12.0％、8.3％、37.0％、53.7％下降为4.6％、1.9％、0.0％、3.7％、2.8％、7.0％、0.9％、0.0％、1.9％、4.6％,P均＜0.05.夜间各种心律失常发生的总次数明显减少(P均＜0.01),HRV各指标均升高(P＜0.01).夜间心律失常总次数与AHI呈正相关,与最低血氧饱和度呈负相关(P均＜0.01).结论对SAS合并心律失常患者,在常规应用心血管药物治疗基础上积极采用NPPV治疗,能降低心律失常发生率,显著减少夜间心律失常发生次数,疗效优于单纯药物治疗.
목적 탐토수면호흡잠정종합정(SAS)합병심률실상환자재상규응용심혈관약물기출상연합무창정압통기(NPPV)치료적의의.방법 선택다도수면감측(PSG)급심전도혹동태심전도학진위중、중도SAS합병심률실상환자135례,안조수궤방법분위NPPV조(69례)화대조조(66례),대조조단순행심내과상규약물치료,NPPV조재상규약물치료기출상가용NPPV,치료3개월후복사상관지표.결과 (1) NPPV조치료전후비교,ESS평분、호흡잠정저통기지수(AHI)、미각성지수균명현하강,분별시8.25 ±5.41화4.08 ±3.43、39.95±7.32화4.71 ±1.80、39.69±4.40화15.20 ±2.05,P균＜0.05；Ⅲ기급쾌속동안기수면시간명현증가최저혈양포화도승고,분별시(4.53±2.10)％화(16.78±2.59)％、(8.37±1.380)％화(15.25±1.41)％、(77.15±6.72)％화(93.35±2.03)％,P균＜0.01.(2) NPPV조치료전후비교,두성심동과완、두성심동과속、두성정박、방성조박、실성조박、단진성방성심동과속、단진성실성심동과속、심방전동、이～삼도방실전도조체、무증상ST-T단개변발생솔유57.4％、44.4％、7.4％、20.4％、13.0％、36.5％、12.0％、8.3％、37.0％、53.7％하강위4.6％、1.9％、0.0％、3.7％、2.8％、7.0％、0.9％、0.0％、1.9％、4.6％,P균＜0.05.야간각충심률실상발생적총차수명현감소(P균＜0.01),HRV각지표균승고(P＜0.01).야간심률실상총차수여AHI정정상관,여최저혈양포화도정부상관(P균＜0.01).결론 대SAS합병심률실상환자,재상규응용심혈관약물치료기출상적겁채용NPPV치료,능강저심률실상발생솔,현저감소야간심률실상발생차수,료효우우단순약물치료.
Objective To investigate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in treatment of patients with arrhythmia complicated by sleep apnea syndrome (SAS).Methods One hundred and thirty-five arrhythmia patients with polysomnography diagnosed SAS were randomly divided into NPPV group (69 cases) and control group (66 cases),the NPPV group was treated with standard medications and NPPV,and the control group was treated with standard medications.SAS related parameters were compared between the groups after 3 months therapy.Results (1) Epworth sleepiness scale (ESS) score,apnea-hypopnea index (AHI) and arousal index were significantly lower (8.25±5.41 vs.4.08±3.43,39.95±7.32 vs.4.71±1.80 and 39.69±4.40 vs.15.20±2.05,P＜0.01) while not rapid eye movement (NREM) Ⅲ and rapid eye movement stage of sleep time and lowest pulse oxygen saturation (LSaO2) were significantly higher in NPPV group than in control group [(4.53 ±2.10)％ vs.(16.78 ±2.59)％,(8.37 ± 1.380)％ vs.(15.25 ± 1.41)％,(77.15 ±6.72)％ vs.(93.35 ± 2.03)％,P ＜ 0.01] after 3 months therapy.(2) Incidence of Sinus bradycardia,sinus tachycardia,sinus arrest,atrial premature beats,ventricular premature beats,paroxysmal atrial tachycardia,paroxysmal ventricular tachycardia,atrial fibrillation,Ⅱ-Ⅲ degree atrioventricular block,ST-T segment changes were reduced from 57.4％,44.4％,7.4％,20.4％,13.0％,36.5％,12.0％,8.3％,37.0％,53.7％ to 4.6％,1.9％,0.0％,3.7％,2.8％,7.0％,0.9％,0.0％,1.9％,4.6％ (allP＜0.05) and the total number of arrhythmias happened at night were significantly lower (all P ＜ 0.05) while the heart rate variability (HRV) were significantly higher (P ＜ 0.01) in NPPV group than in control group; AHI was positively while LSaO2 was negatively correlated with the total night arrhythmia number (P ＜ 0.01).Conclusion Noninvasive positive pressure ventilation is an effective therapy strategy for treating patients with arrhythmia complicated by sleep apnea syndrome.