持续气道正压通气对重度阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血压及血清瘦素水平的影响研究

目的探讨持续气道正压通气(CPAP)对重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者血压及血清瘦素水平的影响。方法选取我院2011年3月—2014年3月收治的资料完整的重度OSAHS合并高血压患者98例,采用随机数字表法分为对照组40例和治疗组58例。对照组患者给予常规降压药物治疗,治疗组患者在常规降压药物治疗基础上给予CPAP。观察两组患者治疗前、治疗6个月后夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(SaO2)、最长呼吸暂停时间、血清瘦素水平。结果组间比较:两组患者治疗前夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、AHI、最低SaO2、最长呼吸暂停时间及血清瘦素水平比较,差异均无统计学意义(P0.05);治疗组患者治疗后夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、AHI及血清瘦素水平低于对照组,最低SaO2高于对照组,最长呼吸暂停时间短于对照组(P0.05)。组内比较:对照组患者治疗后24 h平均收缩压、24 h平均舒张压较治疗前降低(P0.05),而治疗前后夜间收缩压、夜间舒张压、AHI、最低SaO2、最长呼吸暂停时间及血清瘦素水平比较,差异均无统计学意义(P0.05);治疗组患者治疗后夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、AHI及血清瘦素水平均较治疗前降低,最低SaO2较治疗前升高,最长呼吸暂停时间较治疗前缩短(P0.05)。直线相关分析结果显示,重度OSAHS合并高血压患者治疗后24 h平均收缩压与AHI呈正相关(r=0.587,P0.05),与最低SaO2呈负相关(r=-0.519,P0.05),与血清瘦素水平呈正相关(r=0.497,P0.05)。结论在常规降压药物治疗基础上联合CAPA治疗可有效减少重度OSAHS合并高血压患者夜间间歇性低氧血症,降低交感神经兴奋性及血清瘦素水平,进而使其血压降低,有利于更好地控制血压。

Effect of Continuous Positive Airway Pressure on Blood Pressure and Serum Leptin Level in Patients with Serve Obstruc-tive Sleep Apnea Hypopnea Syndrome Accompanied by Hypertension

Objective To investigate the effect of continuous positive airway pressure（ CPAP） on blood pressure and serum leptin level in patients with severe obstructive sleep apnea hypopnea syndrome（ OHASH） accompanied by hypertension.Methods A total of 98 patients with severe OHASH accompanied by hypertension admitted to our hospital from March 2011 to March 2014 were selected,and they were divided into control group（ n = 40） and treatment group（ n = 58） according to random number table. Control group given conventional antihypertensive drugs,while treatment group given CPAP based on antihypertensive drugs. Before treatment and 6 months after treatment,systolic blood pressure at night（ NSBP）,diastolic blood pressure at night（ NSDP）,24 h- mean systolic blood pressure（ 24 hSBP）,24 h- mean diastolic blood pressure（ 24 hSDP）,apnea hypopnea index（ AHI）,the lowest SaO2,the longest apnea time and serum leptin level of the two groups were observed.Results Comparison of inter- group showed that,there was no significant differences of NSBP,NSDP,24 hSBP,24 hSDP,AHI,the lowest SaO2,the longest apnea time and serum leptin level before treatment（ P〉0.05）; NSBP,NSDP,24 hSBP,24 hSDP,AHI and serum leptin level of treatment group were lower than those of control group,the lowest SaO2 was higher and the longest apnea time was shorter（ P〈0. 05）. Comparison of intra- group showed that,24 hSBP,24 hSDP after treatment of control group were lower than before treatment（ P〈0. 05）,but there was no significant differences of NSBP,NSDP,AHI,the lowest SaO2,the longest apnea time and serum leptin level（ P〉0.05）; NSBP,NSDP,24 hSBP,24 hSDP,AHI and serum leptin level after treatment of treatment group were lower than before treatment,the lowest SaO2 was higher and the longest apnea time was shorter（ P〈0. 05）. Linear correlation analysis results showed that,24 hSBP after treatment in patients with severe OHASH accompanied by hypertension was positively correlated with AHI（ r = 0. 587,P〈0