经鼻持续气道内正压治疗高血压性心脏病慢性心力衰竭伴重度阻塞型睡眠呼吸暂停低通气综合征患者的疗效分析

目的 探讨经鼻持续气道内正压（nCPAP）治疗高血压性心脏病慢性心力衰竭（CHF）伴重度阻塞型睡眠呼吸暂停低通气综合征（OSAHS）患者的临床疗效.方法 选择高血压性心脏病CHF伴重度OSAHS患者50例.按随机数字表法分为治疗组和对照组.治疗组25例接受nCPAP及常规药物治疗,对照组25例只接受常规药物治疗,均治疗3个月.比较两组治疗前后心功能分级、血压、左心室舒张末期内径（LVDd）、左心室射血分数（LVEF）、脑钠肽（BNP）、高敏C反应蛋白（hs-CRP）的变化.结果 治疗组的有效率明显高于对照组76.00％（19/25）比40.00％（10/25）],差异有统计学意义（P＜0.05）.两组治疗后血压均显著下降治疗组：（127.52±10.38）/ （72.44±4.92） mmHg（1mmHg =0.133 kPa）比（176.80±12.90）/（100.44±5.55） mmHg;对照组：（150.12±18.96）/（81.64±9.42） mmHg比（176.00±11.69）/（96.08±18.59） mmHg],且治疗组治疗后血压下降更明显,差异均有统计学意义（P＜ 0.01或＜0.05）.治疗组治疗后LVDd、BNP、hs-CRP较治疗前显著下降（49.12±3.18） mm比（57.44±3.62） mm、525.52 ng/L比785.25 ng/L、（7.76±1.69） mg/L比（18.04±2.58） mg/L]; LVEF显著升高（46.12±2.52）％比（38.68±4.65）％],差异均有统计学意义（P＜0.01）.对照组治疗后LVDd、LVEF与治疗前比较差异无统计学意义（P＞0.05）,BNP、hs-CRP与治疗前比较显著下降668.66 ng/L比850.96 ng/L、（12.88±2.02） mg/L比（19.40±2.30） mg/L],但下降幅度低于治疗组,差异均有统计学意义（P＜ 0.05或＜0.01）.结论 对于高血压性心脏病CHF伴重度OSAHS患者,nCPAP能有效改善心力衰竭症状,降低血压,改善心功能,减轻炎性反应.

Effect of nasal continuous positive airway pressure on patients with chronic heart failure due to hypertensive heart disease complicated with severe obstructive sleep apnea hypopnea syndrome

Objective To investigate the clinical efficiency of nasal continuous positive airway pressure （nCPAP） on patients with chronic heart failure（CHF） due to hypertensive heart disease complicated with severe obstructive sleep apnea hypopnea syndrome （OSAHS）.Methods Fifty cases with CHF due to hypertensive heart disease complicated with severe OSAHS were divided into treatment group and control group with 25 cases each by the method of random digits table.nCPAP and routine drug treatment were administered in treatment group,while only routine drug treatment was given in control group.Cardiac functional grading,blood pressure,left ventricular end diastolic dimension （LVDd）,left ventricular ejection fraction （LVEF）,B-type natriuretic peptide （BNP）,high-sensitivity C-reactive protein （hs-CRP） were compared before and after 3-month therapy.Results The effective rate in treatment group was significantly higher than that in control group 76.00％（19/25） vs.40.00％（10/25）],and there was significant difference （P ＜0.05）.There was significantly decreased in blood pressure in two groups at the end of the therapy treatment group：（127.52 ± 10.38）/（72.44 ±4.92） mmHg（1 mmHg =0.133 kPa） vs.（176.80 ± 12.90）/ （100.44 ±5.55） mmHg;control group：（150.12 ± 18.96）/ （81.64 ±9.42） mmHg vs.（176.00 ± 11.69）/ （96.08 ± 18.59） mmHg] （P ＜ 0.01）,but the blood pressure was significantly lower in treatment group than that in control group （P ＜0.05）.LVDd,BNP and hs-CRP in treatment group was declined significantly （49.12 ± 3.18） mm vs.（57.44 ± 3.62） mm,525.52 ng/L vs.785.25 ng/L,（7.76 ± 1.69） mg/L vs.（18.04 ± 2.58） mg/L]（P＜ 0.01）;LVEF was significantly increased （46.12 ± 2.52）％ vs.（38.68 ± 4.65）％]（P＜ 0.01）.There was no significant difference in LVDd and LVEF in control group before and after therapy （P ＞ 0.05）.BNP and hs-CRP also were declined significantly 668.66 ng/L vs.850.96 ng/L,（12.88 ± 2.02） mg/L vs.（19.40 ± 2.30） mg/L] （P ＜ 0.05 or ＜ 0.01）,but the above two were significantly lower in treatment group than those in control group（P ＜ 0.05）.Conclusion nCPAP therapy can effectively improve the symptoms of heart failure,decrease blood pressure,improve cardiac function,reduce the inflammation response to patients with CHF due to hypertensive heart disease complicated with severe OSAHS.