无创持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者心脏亚临床功能障碍的探究
|
摘要
目的:分析无创持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)患者的亚临床心脏形态及其部分功能的影响。方法:选择2015年6月至2017年6月在我院接受检查和治疗的OSAS患者85例,同时纳入35例健康受试者作为对照组。常规多普勒超声心动图、多普勒心肌组织成像和斑点追踪二维超声心动图检测两组受试者临床基本特征及基线时、无创CPAP治疗时和治疗后心脏形态及其部分功能的数据。结果:OSAS组与对照组相比,左心室舒张早期快速充盈的充盈峰(E峰)与二尖瓣环运动峰值(Ea)速度比值(E/Ea)、三尖瓣环收缩偏移(TAPSE)、右心室室壁厚度、右心室内径、侧壁三尖瓣环收缩期峰值速度差异无统计学意义(P均> 0.05),但肺动脉压较高[(35.9±14.6)mmHg vs (24.4±11.7)mmHg,P<0.001,1 mmHg=0.133 kPa]。无创CPAP治疗期间和治疗后6~8个月左心室后壁厚度、舒张末期内径和收缩末期内径参数与治疗前基本一致,但左心室射血分数增加(P均<0.05),E/Ea显著降低(P均<0.05)。左心室多普勒心肌组织成像显示,无创CPAP治疗期间和治疗后6~8个月室间隔基底段E峰速度、舒张晚期充盈的充盈峰(A峰)速度、基底段侧壁E峰速度和三尖瓣血流E波速度显著改善(P均<0.05);左心室侧壁(基底段、中间段和心尖段)、室间隔(基底部、中部和心尖部)和整体心肌应变显著改善(P均<0.05)。治疗期间睡眠呼吸暂停低通气指数(AHI)也较治疗前显著改善[(35.3±12.9)次/h vs(7.2±5.6)次/h,P<0.001]。结论:无创CPAP不仅可以减轻OSAS的严重程度,也可以改善OSAS患者左心室功能。
Objectives: To analyze the impact of noninvasive ventilation on cardiac morphology and function in patients with obstructive sleep apnea syndrome(OSAS).Methods: 85 OSAS patients undergoing examination and treatment in our hospital from June 2015 to June 2017 were enrolled in this study. 35 healthy volunteers served as controls. Conventional Doppler echocardiography, Doppler myocardial tissue imaging and two-dimensional speckle tracking echocardiography were performed to monitor the left and right ventricular functions at baseline and during continuous positive airway pressure(CPAP, 48 h) therapy and at 6-8 months post CPAP. Results: There was no significant difference in E/Ea ratio, TAPSE, right ventricular wall thickness, inner diameter and Sm peak velocity between the OSAS group and the control group, but the pulmonary artery pressure was significantly higher in the OSAS group compared to control group([35.9±14.6] mmHg vs [24.4±11.7] mmHg, P<0.001). The Left ventricular posterior wall thickness, end-diastolic diameter and end-systolic diameter were similar before CPAP treatment and during CPAP treatment and after CPAP treatment(6-8 months), but the left ventricular ejection fraction increased during treatment and after treatment(both P<0.05) as compared to baseline level. The E/Ea ratio during treatment and after treatment wassignificantly lower than at baseline in OSAS patients(both P<0.05). Doppler myocardial imaging of left ventricle showed E peak(filling peak of rapid filling in the early left ventricular diastolic phase)velocity, A peak(peak filling in late diastolic filling phase)velocity, basal segment E peak velocity of the basal segment, and tricuspid blood flow E wave velocity were significantly improved during and after treatment as compared to baseline level in OSAS patients(all P<0.05). Left ventricular wall(basal segment, middle segment and apical segment), ventricular septum(basal, central and apical) and overall myocardial strain were significantly improved during and after treatment as compared to baseline(all P<0.05). AHI was also significantly improved during treatment compared with before treatment [(35.3±12.9)/h vs(7.2±5.6)/h, P<0.001]. Conclusions: Noninvasive ventilation can not only reduce the severity of OSAS, but also improve the left ventricular function of patients with OSAS.
Objectives: To analyze the impact of noninvasive ventilation on cardiac morphology and function in patients with obstructive sleep apnea syndrome(OSAS).Methods: 85 OSAS patients undergoing examination and treatment in our hospital from June 2015 to June 2017 were enrolled in this study. 35 healthy volunteers served as controls. Conventional Doppler echocardiography, Doppler myocardial tissue imaging and two-dimensional speckle tracking echocardiography were performed to monitor the left and right ventricular functions at baseline and during continuous positive airway pressure(CPAP, 48 h) therapy and at 6-8 months post CPAP. Results: There was no significant difference in E/Ea ratio, TAPSE, right ventricular wall thickness, inner diameter and Sm peak velocity between the OSAS group and the control group, but the pulmonary artery pressure was significantly higher in the OSAS group compared to control group([35.9±14.6] mmHg vs [24.4±11.7] mmHg, P<0.001). The Left ventricular posterior wall thickness, end-diastolic diameter and end-systolic diameter were similar before CPAP treatment and during CPAP treatment and after CPAP treatment(6-8 months), but the left ventricular ejection fraction increased during treatment and after treatment(both P<0.05) as compared to baseline level. The E/Ea ratio during treatment and after treatment wassignificantly lower than at baseline in OSAS patients(both P<0.05). Doppler myocardial imaging of left ventricle showed E peak(filling peak of rapid filling in the early left ventricular diastolic phase)velocity, A peak(peak filling in late diastolic filling phase)velocity, basal segment E peak velocity of the basal segment, and tricuspid blood flow E wave velocity were significantly improved during and after treatment as compared to baseline level in OSAS patients(all P<0.05). Left ventricular wall(basal segment, middle segment and apical segment), ventricular septum(basal, central and apical) and overall myocardial strain were significantly improved during and after treatment as compared to baseline(all P<0.05). AHI was also significantly improved during treatment compared with before treatment [(35.3±12.9)/h vs(7.2±5.6)/h, P<0.001]. Conclusions: Noninvasive ventilation can not only reduce the severity of OSAS, but also improve the left ventricular function of patients with OSAS.
引文
[1] Basoglu OK, Vardar R, Tasbakan MS, et al. Obstructive sleep apnea syndrome and gastroesophageal reflux disease:the importance of obesity and gender[J]. Sleep&Breathing, 2015, 19(2):585-592.DOI:10.1007/s 11325-014-1051-4.
[2] Vitarelli A, Terzano C, Saponara M, et al. Assessment of right ventricular function in obstructive sleep apnea syndrome and effects of continuous positive airway pressure therapy:apilotstudy[J]. Can J Cardiol, 2015, 31(7):823-831. DOI:10.1016/j.cjca.2015.01.029.
[3] Koseoglu HI, Altunkas F, Kanbay A, et al. Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome[J]. J Thromb Thrombolysis, 2015, 39(2):179-185. DOI:10.1007/s11239-014-1103-4.
[4] Wons AM, Kohler M. Established vascular effects of continuous positive airway pressure therapy in patients with obstructiv sleep apnoea-an update[J]. J Thorac Dis, 2015, 7(5):912-919.DOI:10.3978/j.issn.2072-1439.
[5]陈建丽,张鹏,徐超,等.无创正压通气对阻塞性睡眠呼吸暂停低通气综合征患者心血管疾病发生率的影响[J].临床肺科杂志,2017, 22(7):1247-1251. DOI:10.3969/j.issn. 1009-6663.2017.07.025.
[6]段兴连,常静.阻塞性睡眠呼吸暂停低通气综合征及其干预治疗对心血管疾病的临床意义[J].心血管病学进展,2016, 37(3):289-292. DOI:10.16806/j.cnki.issn.1004-3934.2016.03.019.
[7]王薇,李丹,黄雪兰,等.实时三维超声心动图对急性心肌梗死经皮冠状动脉介入治疗前后左心室功能变化的评价[J].中国全科医学,2015, 18(27):3371-3375. DOI:10.3969/j.issn. 1007-9572.2015.27.024.
[8]万林林,吴文芳,方玲玲,等.实时三维超声心动图评价心肌梗死患者左室收缩功能的研究[J].临床超声医学杂志,2015, 17(6):375-378. DOI:10.16245/j.cnki.issn1008-6978.2015.06.005.
[9]曹娟,王春,郑闻,等.阻塞性睡眠呼吸暂停低通气综合征与心血管结构改变关系分析[J].现代医学,2015, 43(1):43-46.DOI:10.3969/j.issn.1674-4721.2012.30.013.
[10]姚丽霞,黄黛,李芳,等.阻塞性睡眠呼吸暂停低通气综合征患者心脏结构及左心室功能的变化[J].山东医药,2016, 56(33):65-67.DOI:10.3969/j.issn.1002-266X-2016.33.023.
[11]周京晶,宣正昊,刘颖,等.经颅多普勒超声监测OSAS患者睡眠呼吸暂停期间的脑血流变化[J].临床和实验医学杂志,2015(5):408-410. DOI:10.3969/j.issn.1671-4695.2015.05.026.
[12] Hammerstingl C, Schueler R, Wiesen M, et al. Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy[J]. PLoS One, 2013,8(10):e76352.DOI:10.1371/joumal.pone.0076352.
[13]黄祥亚,李雄英,何添标,等.肥胖与阻塞性睡眠呼吸暂停低通气综合征的关系研究[J].实用心脑肺血管病杂志,2016, 24(1):79-81. DOI:10.3969/j.issn.1674-4721.2012.30.013.
[14]李芳,李长风,郭燕,等.武汉市老年人超重肥胖流行特征与常见慢性疾病的关系[J].中华疾病控制杂志,2016, 20(11):1092-1094.DOI:10.16462/j.cnki.zhjbkz.2016.11.004.
[2] Vitarelli A, Terzano C, Saponara M, et al. Assessment of right ventricular function in obstructive sleep apnea syndrome and effects of continuous positive airway pressure therapy:apilotstudy[J]. Can J Cardiol, 2015, 31(7):823-831. DOI:10.1016/j.cjca.2015.01.029.
[3] Koseoglu HI, Altunkas F, Kanbay A, et al. Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome[J]. J Thromb Thrombolysis, 2015, 39(2):179-185. DOI:10.1007/s11239-014-1103-4.
[4] Wons AM, Kohler M. Established vascular effects of continuous positive airway pressure therapy in patients with obstructiv sleep apnoea-an update[J]. J Thorac Dis, 2015, 7(5):912-919.DOI:10.3978/j.issn.2072-1439.
[5]陈建丽,张鹏,徐超,等.无创正压通气对阻塞性睡眠呼吸暂停低通气综合征患者心血管疾病发生率的影响[J].临床肺科杂志,2017, 22(7):1247-1251. DOI:10.3969/j.issn. 1009-6663.2017.07.025.
[6]段兴连,常静.阻塞性睡眠呼吸暂停低通气综合征及其干预治疗对心血管疾病的临床意义[J].心血管病学进展,2016, 37(3):289-292. DOI:10.16806/j.cnki.issn.1004-3934.2016.03.019.
[7]王薇,李丹,黄雪兰,等.实时三维超声心动图对急性心肌梗死经皮冠状动脉介入治疗前后左心室功能变化的评价[J].中国全科医学,2015, 18(27):3371-3375. DOI:10.3969/j.issn. 1007-9572.2015.27.024.
[8]万林林,吴文芳,方玲玲,等.实时三维超声心动图评价心肌梗死患者左室收缩功能的研究[J].临床超声医学杂志,2015, 17(6):375-378. DOI:10.16245/j.cnki.issn1008-6978.2015.06.005.
[9]曹娟,王春,郑闻,等.阻塞性睡眠呼吸暂停低通气综合征与心血管结构改变关系分析[J].现代医学,2015, 43(1):43-46.DOI:10.3969/j.issn.1674-4721.2012.30.013.
[10]姚丽霞,黄黛,李芳,等.阻塞性睡眠呼吸暂停低通气综合征患者心脏结构及左心室功能的变化[J].山东医药,2016, 56(33):65-67.DOI:10.3969/j.issn.1002-266X-2016.33.023.
[11]周京晶,宣正昊,刘颖,等.经颅多普勒超声监测OSAS患者睡眠呼吸暂停期间的脑血流变化[J].临床和实验医学杂志,2015(5):408-410. DOI:10.3969/j.issn.1671-4695.2015.05.026.
[12] Hammerstingl C, Schueler R, Wiesen M, et al. Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy[J]. PLoS One, 2013,8(10):e76352.DOI:10.1371/joumal.pone.0076352.
[13]黄祥亚,李雄英,何添标,等.肥胖与阻塞性睡眠呼吸暂停低通气综合征的关系研究[J].实用心脑肺血管病杂志,2016, 24(1):79-81. DOI:10.3969/j.issn.1674-4721.2012.30.013.
[14]李芳,李长风,郭燕,等.武汉市老年人超重肥胖流行特征与常见慢性疾病的关系[J].中华疾病控制杂志,2016, 20(11):1092-1094.DOI:10.16462/j.cnki.zhjbkz.2016.11.004.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |