悬雍垂腭咽成形术对阻塞性睡眠呼吸暂停低通气综合征患者难治性高血压的影响

Effect of uvulopalatopharyngoplasty on obstructive sleep apnea hypopnea syndrome in patients with resistant hypertension

目的探讨悬雍垂腭咽成形术（UPPP）对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并难治性高血压患者的影响。方法36例中度和重度OSAHS患者合并难治性高血压[服用3种以上降压药物治疗（其中包括利尿剂）仍不能将收缩压和舒张压控制在140／90mmHg（1mmHg=0．133kPa）]，行UPPP治疗。术前及术后6个月行多道睡眠图监测和动态血压监测，记录血压及呼吸暂停低通气指数（AHI）、最低血氧饱和度（SaO，）等，比较手术前后服用降压药物种类的变化。结果36例患者UPPP治疗总有效率61．1％（22／36），手术后6个月与术前相比，AHI中位数[25分位数；75分位数]由37．5[26．0；48．3]次／h降至9．5[9．0；21．3]础h，最低Sa02平均值（元±s，下同）由0．655±0．114升高至0．860±0．037，差异均有统计学意义（P值均〈0．05）。24h收缩压，日间收缩压，夜间收缩、舒张和平均动脉压分别由（160．8±6．8）、（170．5±2．5）、（163．6±10．5）、（100．8±5．6）和（96．8±7．5）mmHg降至（142．5±7．3）、（150．8±7．6）、（140．1±6．4）、（81．8±7．4）和（93．7±2．4）mmHg，差异均有统计学意义（P值均〈0．05）。AHI下降程度、平均SaO2改善程度与收缩压、舒张压下降程度相关（r值均〉0．80，F2均〉0．50）。36例患者服用降压药物种类较术前（3．6±0．5）种减少至（2．9±0．5）种，差异有统计学意义（t=5．537，P〈0．01），其中23例（63．8％）术后服用降压药物的品种数量较术前减少。结论合并难治性高血压的中度和重度的OSAHA患者行UPPP术后可有效改善血压，减少降压药物的使用。

Objective To investigate the effect of uvulopalatopharyngoplasty （UPPP） to obstructive sleep apnea hypopnea syndrome （OSAHS） in patients with resistant hypertension （RH）. Methods UPPP and modified UPPP were performed on 36 moderate and severe OSAHS patients, who also suffered from RH [ who taking more than three kinds of antihypertensive drugs （ including diuretics ） and still not able to control blood pressure at 140/90 mm Hg （1 mm Hg = 0. 133 kPa）]. Polysomnography monitoring, ambulatory blood pressure monitoring, apnea hypopnea index （ AHI ） , lowest saturation of blood oxygen （ SaO2 ） and the changes of antihypertensive medication dosage were performed to the patients before and 6 months after the surgery. Results Six months after surgery,the total efficiency was 61.1% （22/36）. The AHI median [ 25 quantile; 75 quantile] from 37.5 [ 26.0; 48, 3 ]/h to 9.5 [ 9.0; 21.3 ]/h, the lowest the SaO2 average （x^-±s, the same below） increased from 0. 655 ±0. 114 to 0. 860 ±0. 037, the differences were statistically significant （ P value 〈 0.05 ）. 24 h systolic blood pressure, daytime systolic blood pressure, night contraction, diastolic and mean arterial pressure decreased from （160.8 ± 6.8）, （170.5 ± 2.5 ）, （163.6 ±10.5）, （100.8 ±5.6） and （96.8 ±7.5） mm Hg to （142.5 ±7.3）, （150.8 ±7.6）, （140.1±6.4）, （81.8 ± 7.4） and （93.7 ± 2.4） mm Hg, the differences were statistically significant （ P 〈 0. 05 ）. The degrees of AHI descent and the average SaO2 improvement were concerned with the degree of systolic blood pressure, diastolic blood pressure decent （r 〉 0.80 and r2 〉 0.50）. The average numbers of antihypertensive drugs decreased form （ 3.6±0.5 ） to （2. 9± 0. 5 ） compared preoperatively and postoperatively, the difference was statistically significant （t = 5. 537, P 〈 0.01）. The use of antihypertensive medication reduced in 23 cases （23/36, 63. 8% ） compared preoperatively and postoperatively. Conclusions The blood pressure of the patients with OSAHS and RH dropped significantly after UPPP surgery. Recent follow-up shows that the varieties of antihypertensive drugs taken in these patients are reduced significantly after operation.