心脏移植术后睡眠呼吸暂停类型变化及机制探讨(附1例报告)

Sleep apnea syndrome in heart transplantation patients:the change of types and mechanism

目的探讨心脏移植术后患者伴发睡眠呼吸暂停综合征(SAS)的类型特点及发病机制。方法总结北京安贞医院2005年3月1例心脏移植患者合并睡眠呼吸暂停综合征的临床资料并进行文献复习。结果本例为男性,44岁,心脏移植术前诊断为中枢性睡眠呼吸暂停综合征(CSAS)。心脏移植术后,长期服用环孢菌素A和泼尼松,体重增加明显并出现类库欣征样体征,经多导睡眠监测图(PSG)检查,为重度阻塞性睡眠呼吸暂停综合征(OSAS),移植前后呼吸暂停的类型发生转变,国外也有类似报道。结论睡眠呼吸暂停是心脏移植的潜在危险因素,移植前后呼吸暂停的类型会发生转变,可能与移植前后心功能状态改变有关。

Objective To study the change of types and mechanism of sleep apnea（SA） before and after heart transplantation in congestive heart failure patients.Methods One case of SAS patient who had underwent heart transplantation was reported and pertinent literatures were reviewed.Results A 44-year-old male had had heart transplantation for 4 years.Before surgery he was diagnosed as central sleep apnea syndrome（CSAS）.He had taken Cyclosporin A and prednisone regularly for a long time and had gained significant amount of weight after the transplantation and developed Cushingoid features as well.The diagnosis of severe obstructive sleep apnea syndrome（OSAS） was confirmed by polysomnography（PSG）.Based on the literatures,SAS was common in congestive heart failure patients before heart transplantation and it was the potentially hazardous to cardiac grafted patients.And the apnea types were different before and after surgery,CSA was the main type in the patients before the transplantation and often with Cheyne-Stokes ventilation（CSV）,while OSA was the dominate type after surgery.Conclusion SAS is the potential hazardous to heart transplantation patients.The types of apnea may be transformed before and after heart transplantation.This change may be related to the improvement of heart function.