摘要
目的 观察经鼻持续气道内正压通气（CPAP）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）伴原发性高血压患者心率和血压节律变异的影响.方法 入选2011年7月至2014年8月门诊就诊、进行睡眠呼吸监测并确诊为OSAHS的原发性高血压患者97例,采用随机数字表将患者分为治疗组（49例）与对照组（48例）,入组后均继续服用降压药物,治疗组在原服用降压药物基础上联合CPAP治疗,疗程均为4周,治疗结束后监测并比较两组24 h动态心电图及24h动态血压水平.结果 ①经CPAP治疗后,治疗组夜24 h RR间期均值的标准差（SDANN夜）[（89.0±21.4） ms]较治疗前水平降低,昼、夜相邻RR间期差值的均方根（rMSSD昼、rMSSD夜）分别为（35.9±17.2） ms和（45.7±18.3） ms,较治疗前水平升高（P＜0.01）;与对照组相比,治疗后治疗组SDANN夜（ms）水平降低,rMSSD昼、rMSSD夜水平升高（P＜0.05或P＜0.01）;②经CPAP治疗后,治疗组夜低频功率（LF夜）[（15.3±5.7）ms]较前降低,夜高频功率（HF夜）水平[（16.3±8.1）ms]较前升高（P＜0.01）;治疗组LF夜（ms）水平较对照组降低,HF夜 （ms）水平升高（P＜0.01）;③经CPAP治疗后,治疗组昼夜收缩压（SBP昼、SBP夜）、夜舒张压（DBP夜）分别为（136.1±13.4） mmHg（1 mmHg =0.133 kPa）、（128.7±9.8） mmHg以及（83.7±7.2） mmHg,均较前降低,并均低于对照组（P＜0.05或P＜0.01）;④对照组晨峰血压和非杓形高血压发生率均明显高于治疗组（P＜0.01）.结论 CPAP可有效调节OSAHS伴原发性高血压病患者心率和血压水平,尤以夜间明显.
Objective To investigate the effect of continuous positive airway pressure therapy （CPAP） on heart rhythm and blood pressure variability in primary hypertensive patients with obstructive sleep apnea/hypopnea syndrome （OSAHS）.Methods Ninety seven patients with OSAHS and primary hypertension were randomly divided into treatment group （n =49） and control group （n =48）.Patients in control group receive antihypertensive medication only,while patients in treatment group received antihypertensive medication in combination with CPAP therapy for 4 weeks.The dynamic electrocardiogram （ESG） and ambulatory blood pressure for 24 h were measured before and after treatment in both groups.Results After CPAP treatment,the night index of standard deviation of the average NN intervals （SDANNniGHt） in treatment group was （89.0 ± 21.4） ms,while the day and night index of square root of the mean squared differences of successive NN intervals （rMSSDday and rMSSDnight） was （35.9 ± 17.2） ms and （45.7 ± 18.3） ms respectively.Compared with those before treatment,the index of SDANNnight was decreased and the indexes of rMSSDday and rMSSDnight were increased （P 〈 0.01）.Compared with control group,the SDANNnight was decreased,and the rMSSDday and rMSSDnight were increased （P 〈 0.01,P 〈 0.05）.After CPAP treatment,the night index of low-frequency power （LFnight） in treatment group was （15.3 ± 5.7） ms,which was lower than that before treatment,and the night index of high-frequency power （HFnigh） was （16.3-± 8.1）ms,which was higher than that before treatment （P 〈 0.01）;the LFnight in treatment group was decreased and the HFnight was increased （P 〈 0.01）.After CPAP treatment,the day and night indexes of systolic blood pressure （SBPday and SBPnight） and the night indexes of diastolic blood pressure （DBPnigh） t in treatment group were （136.1 ± 13.4） mmHg,（128.7 ± 9.8） mmHg （1 mmHg =0.133 kPa）,and（83.7 ±7.2）mmHg respectivley,which were all lower than those in control group （P 〈 0.05 or P 〈 0.01）.The incidences of morning peak blood pressure and non-dipper hypertension in control group were significantly higher than those in treatment group （P 〈 0.01）.Conclusion CPAP therapy can effectively adjust the heart rate and blood pressure levels in patients with OSAHS and primary hypertension,especially in the night.
出处
《中华全科医师杂志》
2015年第8期603-606,共4页
Chinese Journal of General Practitioners
