血栓弹力图在OSAHS并发慢性心力衰竭患者中的应用价值

目的 通过血栓弹力图评估阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome，OSAHS）并发慢性心力衰竭（CHF）患者的血凝状态，探讨血栓弹力图在OSAHS并发CHF患者中的应用价值。 方法 选择确诊为OSAHS并发CHF患者60例，按照2015年我国《阻塞性睡眠呼吸暂停低通气综合征诊治指南（基层版）》诊断标准中的睡眠呼吸指数（AHI），将OSAHS并发CHF患者分为轻度组（20例，AHI 5~15次/h）、中度组（20例，AHI 16~30次/h）和重度组（20例，AHI>30次/h）。另随机选取同一时段我院健康体检者20例作为正常对照组，所有入组患者均记录一般情况，包括年龄、身高、体质量、性别、高血压病、吸烟史、饮酒史、腰围、睡眠监测结果、血栓弹力图结果（R值、MA值）。 结果 ①随着OSAHS并发CHF患者体质量指数（body mass index，BMI）的升高，AHI相应增大，差异有统计学意义（P<0.05）。②OSAHS并发CHF患者各组与正常对照组比较，R值明显减小，差异有统计学意义（P<0.05）。OSAHS并发CHF患者各组间R值比较，差异有统计学意义（P<0.05）。③OSAHS并发CHF患者各组与正常对照组比较，MA值明显增大，差异有统计学意义（P<0.05，P<0.01）。OSAHS并发CHF患者各组间MA值比较，差异有统计学意义（P<0.05，P<0.01）。 结论 OSAHS并发CHF患者病情越重R值越小、MA值相应增大。

Application and evaluation of thromboelastography in obstructive sleep apnea hypopnea syndromes patients with chronic heart failure

AIM To explore the value of thromboelastography in obstructive sleep apnea hypopnea syndromes (OSAHS) patients with chronic heart failure (CHF). METHODS A total of 60 CHF patients diagnosed by polysomnography and cardiology in our hospital were divided into three groups:a mild group (n=20), a moderate group (n=20) and a severe group (n=20). In addition, 20 healthy subjects were selected as a control group. General data were recorded, including age, height, weight, gender, hypertension, smoking history, drinking history and waist circumference. All patients were monitored by polysomnography and thromboelastogram was performed. Blood samples were monitored to detect the time at which the first blood clot was formed (R value) and the maximum coagulation strength (MA) on thromboelastography. The changes of thromboelastogram in serum samples were studied to evaluate the value and the correlation of thromboelastography in OSAHS patients with CHF. RESULTS AHI increased with increase of body mass index (BMI) in mild, moderate and severe OSAHS patients with CHF (P<0.05). Compared with that in control group, the R of OSAHS patients with CHF was significantly lower (P<0.05). The difference between mild, moderate and severe groups was significant (P<0.05). Compared with the control group, the MA value of patients with CHF was significantly higher than that in the control group (P<0.05). The MA of the moderate group and the mild group was significantly higher than that of the control group (P<0.05, P<0.01). The difference between mild, moderate and severe groups was significant(P<0.05, P<0.01). CONCLUSION In OSAHS patients with CHF, BMI is positively correlated with AHI, R value is negatively correlated with AHI and MA value is positively correlated with AHI. The blood of OSAHS patients with CHF is in hypercoagulable states and the more serious the condition of OSAHS patients is, the more serious the blood hypercoagulability state is. Thromboelastography can be used to evaluate the hemagglutination status of OSAHS patients with CHF and to guide antiplatelet aggregation and anticoagulant therapy in clinical practice.