阻塞性睡眠呼吸暂停低通气综合征并新诊断的高血压手术治疗后血压变化观察

目的观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并新诊断高血压病患者手术治疗后血压的变化情况。方法选择2012年9月至2014年3月在甘肃省人民医院鼾病科手术治疗的OSAHS合并新诊断的高血压病患者102例,分别行鼻中隔黏膜下矫正术、鼻内镜下鼻窦开放术、鼻息肉摘除术、腭咽成形术,术前及术后3、6个月进行多导睡眠监测、24 h动态血压监测、胸部X线摄片、纤维鼻咽镜等检查;观察术后3、6个月的血压变化。结果手术治疗后3、6个月患者体质指数（BMI）无明显变化,呼吸紊乱指数（AHI）和平均呼吸暂停时间较术前均显著下降,平均血氧饱和度（Sp O2）较术前显著升高（P均〈0.05）。手术治疗后3、6个月患者静息状态下的收缩压和舒张压、全天平均收缩压和舒张压、白天平均收缩压和舒张压、夜间平均收缩压和舒张压均较术前下降（P均〈0.05）,其中夜间平均收缩压和平均舒张压的下降更明显。静息状态下的收缩压和舒张压、平均收缩压和舒张压在术后3个月和6个月之间比较差异无统计学意义（P均〉0.05）。所有患者在手术治疗后的静息状态下血压恢复正常58例,缓解率为56.9%。结论 OSAHS相关高血压患者术前综合评估,确定个体化术式,术后辅助综合治疗,可收到良好降压效果。

Changes of postoperative blood pressure in OSAHS patients with newly diagnosed,hypertension

Objective To observe the blood pressure （BP）changes and clinical effect after surgical treatment in obstructive sleep apnea/hypopnea syndrome （OSAHS） patients with newly diagnosed hypertension. Methods A total of 102 patients with OSAHS complicated with newly diagnosed hypertension by surgery treatment in the department of sleep disorder of Gansu Provincial Hospital between September 2012 and March 2014 were enrolled in this study. The diorthosis under nasal septum mucosa, the sinus open operation under the nasal endoscope, the nasal polyp excision and palatopharyngoplasty were respectively performed for the patients. At 3- and 6-month after operation, polysomgography （PSG） monitoring, chest X-rays, 24-hour ambulatory BP monitoring and fiber nasopharyneal mirror examination were performed, and the BP changes were observed. Results Compared with pre-operation, the body weight index（BMI） had no obvious change;the apnea/hypopnea index （AHI） and the average apnea time reduced significantly;the average oxygen saturation（ SpO2 ） increased significantly （ all P 〈 0.05 ） ; the systolic blood pressure （SBP） and diastolic blood pressure （DBP） at rest state, as well as the average SBP and DBP in the whole day, the daytime and the night descended significantly （ all P 〈0. 05 ） ; the average SBP and DBP in the night decreased significantly compared with the other times at 3- and 6-month after operation. Compared with 3-month after operation, the SBP and DBP at rest state and the average SBP and DBP at 6-month after operation remained unchanged （all P 〉 O. 05 ）. The patients returned to normal BP range at rest state were found in 58 cases（remission rate： 56.9% ）. Conclusion The comprehensive preoperative assessment to make individualized surgery scheme and postoperative comprehensive auxiliary treatment can achieve a better blood pressure-lowering effect for OSAHS-related hypertension.