伴有阻塞性呼吸睡眠暂停综合征的高血压患者术后经鼻持续气道正压通气治疗对血压控制的研究

Effect of Post-operation Nasal Continuous Positive Airway Pressure on Patients with Hypertension Combined with Obstructive Sleep Apnea Syndrome

目的研究伴有阻塞性呼吸睡眠暂停综合征(OSAHS)的高血压患者术后予经鼻持续气道正压通气(nCPAP)治疗的血压控制情况。方法选取2008年3月—2012年12月我院收治的高血压合并OSAHS患者193例,将其随机分为观察组118例和对照组75例。两组患者均接受高血压治疗,观察组在此基础上,术后接受nCPAP治疗。观察两组不同病程(≤5年和>5年)、不同血压水平(轻度、中度和重度)、不同呼吸暂停低通气指数(AHI)(轻度、中度和重度OSAHS)患者治疗前、后的24 h动态血压,两组AHI及动脉血氧饱和度(SaO2)。结果治疗前两组AHI、SaO2比较,差异均无统计学意义(P>0.05);治疗后观察组AHI低于对照组,SaO2高于对照组(P<0.01)。经nCPAP治疗后,观察组轻中度OSAHS、轻中度高血压、病程≤5年的患者收缩压和舒张压均低于对照组(P<0.05);两组重度OSAHS、重度高血压、病程>5年的患者收缩压和舒张压比较,差异均无统计学意义(P>0.05)。结论对于病程<5年、轻中度OSAHS、轻中度高血压患者术后采用nCPAP治疗是一种安全有效的降压方法,而对于重度OSAHS、病程≥5年、重度高血压患者应继续服用药物治疗。

Objective To observe the effect of post - operation nasal continuous positive airway pressure （nCPAP） on patients with hypertension combined with obstructive sleep apnea syndrome （OSAHS）. Methods 193 patients with hyperten- sion combined with OSAHS admitted to our hospital from March 2008 to December 2012 were randomly divided into groups obser- vation （118 cases） and control （75 cases）. Both groups were given treatment of hypertension, observation group were given nCPAP alonely after operation. The ambulatory blood pressure, AHI and SaO, between two groups of different coursee, different level of blood pressure and different AHI before and after treatment were compared. Results Before treatment, the AHI and SaO2 between two groups showed no significant differences （P 〉 0. 05） ; after treatment, the AHI in observation group was lower than that of control group, SaO2 was higher （P 〈0. 01） . After treatment, blood pressure of mild to moderate OSAHS, mild to moderate hypertension, duration ≤5 years in observation group was lower than that of control group （P 〈 0. 05） ; blood pressure of severe OSAHS, severe hypertension, duration 〉 5 years between two groups showed no significant differences （P 〉 0. 05）. Conclusion The hypertension patients of duration 〈 5 years, mild to moderate OSAHS, mild to moderate hypertension should given treatment of nCPAP. The hypertension patients of severe OSAHS, duration≥5 years, severe hypertension should given treatment of medication.