重叠综合征患者动态血压监测的临床研究

The Clinical Study of the Ambulatory Blood Pressure in Overlap Syndrome

目的探讨重叠综合征动态血压的特点、发生机制及持续气道内正压通气治疗的意义。方法对36例重叠综合征、30例COPD患者进行24小时血压监测,PSG监测,记录24hMSBP、24hMDBP、24hMHR、dMSBP、dMDBP、dMHR、nMSBP、nMDBP、nMHR及AHI、Lapnea、LSaO2、SaO2<90%时间。结果重叠综合征24小时动态血压整体水平、白昼水平、夜间水平及AHI、Lapnea、SaO2<90%时间较单纯COPD患者明显增加;血压昼夜节律消失;LSaO2较单纯COPD患者明显下降;重叠综合征患者24hMSBP、24hMDBP、dMSBP、dMDBP、nMSBP、nMDBP与AHI、SaO2<90%时间呈正相关,与LSaO2呈负相关;持续气道内正压通气治疗后,24小时动态血压整体水平、白昼水平、夜间水平及AHI、Lapnea、SaO2<90%时间较治疗前明显下降;血压昼夜节律改善;LSaO2较治疗前明显上升。结论重叠综合征较单纯COPD患者血压升高、血压昼夜节律消失,夜间低氧明显;血压升高与呼吸暂停、夜间低氧有关;持续气道正压通气能改善重叠综合症患者的血压水平。

Objective To explore the characteristics and pathogenesis of the ambulatory blood pressure in patients with overlap syndrome and the clinical significance of CPAP. Methods 36 cases of overlap syndrome and 30 cases of chronic obstructive pulmonary disease （COPD） were examined and monitored with polysomnography and ambulatory blood pressure which including 24 hours mean systolic blood pressure （24 hMSBP）, and 24 hours mean diastolic blood pressure （24hMDBP）, and 24 hours mean heart rate （24hMHR）. It was also recorded the items that were the day mean systolic blood pressure （dMSBP）, day mean diastolic blood pressure （dMDBP）, day mean heart rate （dMHR）, and night mean systolic blood pressure （nMSBP）, night mean diastolic blood pressure （nMDBP）, night mean heart rate （nMHR）, apnea hypopnea index （AHI）, the longest time of apnea （L apnea）, the lowest oxygen saturation （L SaO2）, and the accumulated time when SaO2 was lower than 90% （ SaO2 〈90%）. Results 24 hMSBP, 24 hMDBP, 24 hMHR, dMSBP, dMDBP, dMHR, nMSBP, nMDBP, nMHR, AHI, L apnea and the accumulated time of Sa O2〈90% in patients of overlap syndrome were significant higher than those of COPD; L SaO2 in patients of overlap syndrome was lower than that of COPD; 24 hMSBP, 24hMDBP, dMSBP, dMDBP, nMSBP, nMDBP were correlated positively with AHI and the accumulated time of SaO2〈90%, and correlated negatively with SaO2 in overlap syndrome. After treated with CPAP, 24 hMSBP, 24 hMDBP, 24 hMHR, dMSBP, dMDBP, dMHR, nMSBP, nMDBP, nMHR, AHI, L apnea and the accumulated time of SaO2〈90% in patients of overlap syndrome were significant lower than those before; L SaO2 was higher than that before. Conclusion Higher blood pressure and hypoxia were found in overlap syndrome; the increased blood pressure was related with apnea and hypoxia; treatment of CPAP can improve blood pressure in overlap syndrome.