持续气道正压通气对OSAHS患者血管内皮细胞功能的影响

目的 :探讨持续呼吸道正压通气 (CPAP)治疗对阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)并发冠心病患者血管内皮细胞功能指标及心肌缺血变化的影响。　方法 :随机选择并发冠心病的中、重度OSAHS且接受CPAP连续治疗 3个月以上的患者 2 3例 ,分别于治疗前和治疗 3个月时比较、分析清晨的血浆一氧化氮 (NO)和内皮素(ET)、NO/ET比值、心肌缺血总负荷 (TIB)、睡眠期呼吸暂停低通气指数 (AHI)、最低和平均脉氧饱和度 (SPO2 )的变化。　结果 :与CPAP治疗前比较 ,治疗 3个月时清晨血浆NO浓度及NO/ET比值升高非常显著 (P <0 .0 1) ,清晨ET浓度下降显著 (P <0 .0 5 ) ;而且睡眠期AHI及最低SPO2 亦降低非常显著 (P <0 .0 1) ,平均SPO2 下降显著 (P <0 .0 5 ) ,心肌TIB较治疗前明显减低 (P <0 .0 5 )。　结论 :CPAP对OSAHS合并冠心病患者的血管内皮细胞功能损害和心肌缺血可起到明显的改善和保护作用。

Effect of continuous positive airway pressure treatment on vascular endothelial function in patients with obstructive sleep apnea and coronary heart disease

Objective: To investigate the changes of vascular endothelial function index and myocardial ischemia in (obstructive sleep apnea hypopnea syndrome,OSAHS) patients with coronary heart disease (CHD) before and during continuous positive airway pressure (CPAP) treatment. Methods:23 patients with moderate-to-severe OSAHS complicated with CHD undergoing three months' CPAP treatment were recruited. The changes of their morning plasma nitric oxide (NO) and endothelin (ET), the rate of NO/ET, total myocardial ischemia burden (TIB), apnea hypopnea index (AHI), minimal and mean pulse oxygen saturation (S P O 2 ) were compared and analyzed before and during CPAP treatment. Results:Compared with parameters before treatment, there were significant increase in morning plasma NO and NO/ET(P < 0.01), decrease in morning plasma ET(P < 0.05), decrease in AHI, minimal S P O 2 (P < 0.01)as well as in mean S P O 2 and TIB(P < 0.05)after three months' CPAP treatment. Conclusion:CPAP treatment plays an important role in improving and protecting on vascular endothelial function and myocardial perfusion for OSAHS patients with CHD.