慢性间歇低氧对心脏B超和血压影响的观察

目的 探讨慢性间歇低氧对OSAHS患者左心功能的影响,以及持续气道正压通气(CPAP)治疗后左心功能和血压的变化.方法 顺序收集2007年5月至2008年12月于吉林大学第一医院就诊的、符合OSAHS诊断标准的门诊或住院患者75例(OSA组),其中非高血压者35例,合并高血压者40例.另选30名健康人为对照组,其中男20名,女10名,年龄30～65岁,与患者组年龄匹配,均为经系统检查无异常发现的健康人.对两组左心室射血分数(left ventricular ejection fraction,LVEF)、短轴缩短率(shortening fraction,FS)、E峰、A峰,并计算E/A进行比较.CPAP治疗后的血压、LVEF、E/A进行分析.结果 所有患者晨起血压(150.80±20.73/108.0±15.34)mm Hg(1 mm Hg=0.133 kPa)均较睡前血压(134.16±18.33/90.09±11.24)mm Hg明显升高.OSA组E/A明显降低(P<0.01),LVEF、FS明显降低(P<0.05);与对照组及OSA非高血压组比较,OSA合并高血压的患者左室射血分数和短轴缩短率均减少,提示高血压的出现是OSA左室收缩功能减退的重要因素;与对照组比较,OSA非高血压组E/A明显降低;非高血压组和高血压组比较,高血压组E/A下降显著,说明OSA本身可直接影响左心室舒张功能,而高血压的出现加重了左心室的舒张功能的降低.经CPAP治疗6个月后晨起血压(142.59±15.34/96.52±9.81)mmHg较治疗前(150.80±20.73/108.0±15.34) mm Hg显著下降(P<0.001);左室射血分数(59.70±11.1)%较治疗前(56.40±9.74)%增加(P<0.05);E/A值1.16±0.25较治疗前0.87±0.17明显增加(P<0.01).结论 (1)CIH可引起左心结构和功能发生改变,高血压的出现加重了这种变化.(2)CPAP对于纠正OSA患者高血压、改善左心功能,提高生活质量有重要意义.

The observation of the influence about blood pressure and cardiovascular B ultrasonic wave by chronic intermittent hypoxia

Objective To investigate the influence of left heart function in obstructive sleep apnea by CIH, and explore left heart function and blood pressures before or after CPAP. Methods 75 OSA were divided into two groups :40 patients blood pressures were coincident with diagnostic standard of hypertension recording;35 patients blood pressures were non-hypertension recording. The control group included 30.healthy adults. The blood pressures before and also after sleep, left ventricular ejection fraction (LVEF),shortening fraction(FS), E, A and E/A were compared with those of normal control subjects. Analyzed BP,LVEF and E/A after CPAP. Results (1)The blood pressure soon after getting up in the morning(150.80±20.73/108.0±15.34) mm Hg(1 mm Hg = 0.133 kPa) was significantly higher than that before sleep (134.16±18.33/90.09±11.24) mm Hg(P < 0.001 ). (2)Multiple parameters including LVEF, FS and E/A, were impaired in OSA patients relative to the control subjects(P <0.05 or P <0.01), OSA affected cardiovascular function directly; E/A was significantly decreased in obstructive sleep apnea unallied hypertension than that in normal control subjects; E/A was conspicuously decreased in obstructive sleep apnea associated hypertension comparing with that in obstructive sleep apnea unallied hypertension. These showed OSA affected cardiovascular function directly, hypertension aggravated the drop in cardiovascular function. 3. After CPAP in 6 months, it (142.59±15.34/96.52±9.81) mm Hg was significantly decreased than that before treatment(150.80±20.73/108.0±15.34) (P < 0. 001 ) ; LVEF (59.70±11.1)% was increased than that before treatment (56.40±9.74)% (P <0. 05) and E/A 1.16 ±0.25 was increased. Than that before treatment 0.87±0.17(P<0.01). Conclusion (1)CIH may affect left heart structure and function; these changes were aggravated with hypertension. (2)CPAP treatment had important sense in the treatment of hypertension and cardiovascular function, and improved the life quality.