腭咽成形术对并存阻塞性睡眠呼吸暂停低通气综合征冠心病患者的影响

Effect of palato-pharyngo-plastry on patients with coronary heart disease plus obstructive sleep apnea hypopnea syndrome

目的 探讨腭咽成形术对阻塞性睡眠呼吸暂停综合征（OSAHS）并存冠心病患者的影响及预后.方法 收集113例OSAHS并存冠心病患者,进行改良腭咽成形术并进行冠心病病情跟踪随访（研究组）,以同期使用持续呼吸道正压通气（CPAP）治疗OSAHS并存冠心病患者125例作为对照（对照组）.结果 两组冠心病基础诱因中血浆胆固醇、三酰甘油、空腹血糖、体质指数两组比较差异均无统计学意义（χ^2或t值分别为4.788、0.479、0.541,均P〉0.05）.睡眠期间研究组血氧饱和度为（91.2±2.5）%,高于对照组的（87.6±4.2）%（t=7.581,P=0.046）.研究组患者冠状动脉造影显示87例（77.0%）病变稳定,24例（21.2%）病变加重,与对照组相比差异无统计学意义（χ^2=0.267,P〉0.05）.研究组37例（32.7%）心绞痛症状加重,较对照组的58例（46.4%）低（χ^2=4.615,p=0.032）.心肌梗死、猝死研究组（3.5%、0.8%）与对照组（5.6%、2.4%）差异无统计学意义（χ^2分别为0.571、0.495,均P〉0.05）.结论 腭咽成形术后OSAHS患者睡眠期间血氧饱和度较CPAP治疗后OSAHS患者明显提高,减轻心绞痛症状较CPAP治疗组更明显,但对延缓冠状动脉粥样硬化进展影响以及对于急性冠状动脉事件影响与CPAP差别不大.

Objective To investigate the effect of palato-pharyngo-plastry on patients with coronary heart disease （CHD） plus obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods The 113 OSAHS patients with CHD after palato-pharyngo-plastry from January 2001 to December 2006 were enrolled and followed up. The other 125 cases treated with continuous positive airway pressure （CPAP） were as control group. Results The fundmental factors of CHD including cholesterol, triglyeride, fasting blood glucose and body mass index （BM1） showed no statistical differences between two groups （χ^2 or t= 4.788, 0.479, 0.541, all P〉0.05） . Only the oxyhemoglobin saturation during sleep was higher in study group than in control group [（91.2± 2.5）% vs. （87.6±4.2）%, P=0.046]. The angiography showed that 87 cases （77.0%） retained stable, 24 cases （21.2%） became severe in study group. As compared with control group, there were no statistical differences （both P〉0.05）. 37 cases （32.7%） in study group and 58 cases （46.4%） in control group who suffered from angina became severe with statistical differences between two groups （χ^2=4.615, P=0.032）. The incidences of myocardial infarction and sudden death were lower in study group （3.5% and 0.8%） and in control group （5.6% and 2.4%）, showed no statistical, difterences be tween twogroups. χ^2=0.571 and 0.495, P〉0. 05）. Conclusions Compared with CPAP, the palato-pharyngo-plastry can improve oxyhemoglobin saturation and reduce angina symptom, but has no better effect on progress of coronary atherosclerosis and acute coronary disease than CPAP.