无创正压通气治疗对冠心病合并阻塞性睡眠呼吸暂停低通气综合征患者心律失常影响研究

Effect of Continuous Positive Airway Pressure Therapy on Arrhythmia in Coronary Heart Disease Patients Combined With Obstructive Sleep Apnea-hypopnea Syndrome

目的：观察无创正压通气治疗对冠心病合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS熄者心律失常影响的研究。方法：将80例冠心病合并OSAHS患者随机分成2组，治疗组40例，标准治疗基础上给予无创机械通气支持，采用持续性正压通气模式，呼吸频率12～16次／min，滴定在6～10cmH2O（1cmH2O=0．098kPa），每晚至少3h。对照组40例，按冠心病指南进行标准治疗。两组均在入选第1天和3个月后检测动态心电图、心脏超声和血清氨基末端B型利钠肽原（NT—proBNP）浓度。主要终点：心律失常负荷的变化。次要终点：心源性死亡、非致命性心肌梗死和植入永久起搏器联合终点。结果：动态心电图监护：治疗组第1天和3个月后的前后差值与对照组第1天和3个月后的前后差值比较，室上性心律失常、室性心律失常、缓慢性心律失常计数显著减少，差异均有统计学意义（P=0．002）；连续24h内正常窦性RR间期的标准差、每5min正常RR间期标准差的平均值、校正的QT值（QTc）、QT间期的离散度（QTd）明显下降，差异均有统计学意义（P〈0．05）。两组患者在3个月内共发生心血管不良事件3例，其中治疗组1例，对照组2例；对照组植入永久起搏器2例，治疗组0例，两组比较差异无统计学意义（P=0．68）。结论：冠心病合并OSAHS患者予兀创机械通气治疗能显著降低心律失常发生。

Objective： To investigate the effect of continuous positive airway pressure therapy on arrhythmia in stable coronary heart disease （SCHD） patients combined with obstructive sleep apnea-hypopnea syndrome （OSAHS）. Methods： A total of 80 SCHD-OSAHS patients were randomized into 2 groups. Treatment group, in which the patients received routine treatment with continuous positive airway pressure therapy, the respiratory rate was kept at 12-16 times/rain, the pressure was at 6-10 cmH2O （1 cmH2O=0.098 kPa） for at least 3 hours per night. Control group, the patients received routine treatment, n=40 in each group. All patients were examined at the 1st day and 3 months after the treatment by ambulatory ECG and echo cardiogram. The primary endpoint events were arrhythmias, the secondary endpoint events were the composite of non-fatal myocardial infarction, cardiac death and permanent pacemaker implantation. Results： Compared with Control group, the Treatment group presented significantly decreased supra ventricular-, ventrieular- and slow arrhythmias at both 1st day and 3 months time points, all P〈0.05; obviously decreased standard deviations of normal sinus R-R interval, the mean value of normal R-R interval for every 5 min, adjusted QTc, QTd in continuous 24 hours, all P〈0.05. The overall endpoint events at 3 months happened in 3 patients, 1 in Treatment group and 2 in Control group. The permanent pacemaker implanted in 2 patients in Control group and 0 in Treatment group, P=0.68. Conclusion： Continuous positive airway pressure therapy may significantly decrease the arrhythmia occurrence in patients with SCHD-OSAHS.