经鼻持续气道正压通气治疗高血压慢性心力衰竭伴重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效分析

目的：探讨经鼻持续气道正压通气（nCPAP）治疗高血压慢性心力衰竭（CHF）伴重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的临床疗效。方法入选高血压慢性心力衰竭伴重度OSAHS患者43例。随机分两组：接受nCPAP及常规药物治疗者23例为治疗组，只接受常规药物治疗者20例为对照组。治疗3个月。比较两组治疗前后心功能分级、血压、睡眠呼吸暂停低通气指数（AHI）、最长低通气时间、夜间平均血氧饱和度（SaO2）、左心室舒张末期内径（LVDd）、左心室射血分数（LVEF）及脑钠肽（BNP）的变化。结果治疗组的治疗总有效率明显高于对照组（P＜0.05）。两组治疗后血压均显著下降（P＜0.01），但治疗组血压下降更显著（P＜0.05）。治疗组治疗后AHI、最长低通气时间、LVDd、BNP显著降低（P＜0.05）；夜间SaO2、LVEF显著提高（P＜0.01）。对照组治疗后AHI、最长低通气时间、夜间平均SaO2、LVDd、LVEF无显著变化（P＞0.05），BNP亦显著下降（P＜0.05）。血压下降程度与BNP下降程度呈正相关趋势。结论对于高血压慢性心力衰竭伴重度OSAHS患者，nCPAP能有效改善心力衰竭症状，降低血压，改善睡眠呼吸暂停和低通气，纠正低氧血症，改善心功能。

Therapeutic efficacy of nasal continuous positive airway pressure on patients with obstructive sleep apnea hypopnea syndrome complicated with hypertention and chronic heart failure

Objective To investigate the clinical efficiency of nasal continuous positive airway pressure （nCPAP） therapy on patients with obstructive sleep apnea hypopnea syndrome complicated with hypertention and CHF. Methods Forty-three cases with OSAHS complicated with hypertention and CHF were randomly divided into treatment group （n=23） and control group （n=20）. nCPAP and routine drug treatment were administered in the treatment group, while only routine drug treatment was given in the control group. Cardiac functional grading, blood pressure, apnea hypopnea index（AHI）, maximum hypopnea time, mean night arterial oxygen saturation （SaO2）, left ventricular end diastolic dimension （LVDd）, left ventricular ejection fraction（LVEF） and B-type natriuretic peptide （BNP） value were compared before and after 3-month therapy. Results The total effective rate of the treatment group was significantly higher than the control group（P〈0.05）. There was a significant decrease in blood pressure in both two groups at the end of the therapy（P〈0.01）, but the blood pressure was significantly lower in treatment group than those in control group（P〈0.05）. AHI, maximum hypopnea time, LVDd and BNP in treatment group declined significantly（P〈0.05）, mean night SaO2 and LVEF were significantly increased（P〈0.01）. There was no significant difference in AHI, maximum hypopnea time, mean night SaO2, LVDd, LVEF to control group after therapy in comparison with before（P〉0.05）, BNP also declined significantly （P〈0.05）.There was positive correlation between the lowering of blood pressure and BNP. Conclusion nCPAP therapy can effectively improve the symptoms of heart failure, decrease blood pressure, improve apnea and hypopnea, correct hypoxemia, improve cardiac function in patients with OSAHS complicated with hypertention and CHF.