经鼻持续气道正压通气联合心脉隆注射液治疗心力衰竭并阻塞性睡眠呼吸暂停低通气综合征的临床疗效观察

Clinical Effect of Nasal Continuous Positive Airway Pressure Ventilation Combined with Xinmailong Injection in Treating Heart Failure Patients Complicated with Obstructive Sleep Apnea Hypopnea Syndrome

目的观察经鼻持续气道正压通气(CPAP)联合心脉隆注射液治疗心力衰竭并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床疗效。方法选取秦皇岛市第二医院2014—2015年收治的心力衰竭并OSAHS患者131例,采用随机数字表法分为A组41例、B组46例、C组44例。3组患者入院后均给予常规治疗,A组患者在常规治疗基础上给予经鼻CPAP治疗3个月,B组患者在常规治疗基础上给予心脉隆注射液治疗10 d,C组患者在常规治疗基础上给予经鼻CPAP治疗3个月联合心脉隆注射液治疗10 d。比较3组患者治疗前后通气功能指标〔睡眠呼吸暂停低通气指数(AHI)、最长低通气时间及最低血氧饱和度(Sa O2)〕、心功能指标〔氨基末端B型脑钠肽前体(NT-pro BNP)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)及左心室舒张末期内径(LVEDD)〕、肾素-血管紧张素-醛固酮系统(RAAS)活性指标〔肾素活性(PRA)及血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平〕及治疗期间不良反应发生情况。结果治疗前3组患者AHI、最长低通气时间、最低Sa O2比较,差异无统计学意义(P>0.05)。治疗后A组和C组患者AHI低于B组,最长低通气时间短于B组,最低Sa O2高于B组(P<0.05);C组患者AHI低于A组,最长低通气时间短于A组(P<0.05),而A组与C组患者最低Sa O2比较,差异无统计学意义(P>0.05)。治疗前3组患者血浆NT-pro BNP水平、LVEF、LVESD、LVEDD比较,差异无统计学意义(P>0.05)。治疗后B组和C组患者血浆NT-pro BNP水平、LVESD、LVEDD低于A组,LVEF高于A组(P<0.05);C组患者血浆NT-pro BNP水平、LVEDD低于B组,LVEF高于B组(P<0.05),而B组与C组患者LVESD比较,差异无统计学意义(P>0.05)。治疗前3组患者血浆PRA、AngⅡ、ALD水平比较,差异无统计学意义(P>0.05);治疗后A组和C组患者血浆PRA、AngⅡ、ALD水平低于B组(P<0.05),C组患者血浆PRA、AngⅡ、ALD水平低于A组(P<0.05)。3组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论经鼻CPAP联合心脉隆注射液可有效改善心力衰竭并OSAHS患者通气功能和心功能,降低血浆NT-pro BNP水平并抑制RAAS活性,且安全性较高。

Objective To observe the clinical effect of nasal continuous positive airway pressure ventilation （nCPAP） combined with xinmailong injection in treating heart failure patients complicated with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods A total of 131 heart failure patients complicated with OSAHS were selected in the Second Hospital of Qinhuangdao from 2014 to 2015, and they were divided into A group （ n = 41 ）, B group （ n = 46） and C group （ n = 44） according to random number table. Patients of the three groups received conventional treatment after admission, meanwhile patients of A group received nCPAP for 3 months, patients of B group received xinmailong injection for 10 days, while patients of C group received nCPAP for 3 months and xinmailong injection for 10 days. Index of ventilation function （ including AHI, the longest duration of hypopnea, the lowest SaO2 ）, index of cardiac function （including NT-proBNP, LVEF, LVESD and LVEDD） and index of RAAS activity （including PRA, plasma levels of Ang Ⅱ and ALD） before and after treatment, and incidence of adverse reactions during the treatment were compared among the three groups. Results No statistically significant differences of AHI, the longest duration of hypopnea or the lowest SaO2 was found among the three groups before treatment （P 〉 0. 05 ）. After treatment, AHI of A group and C group was statistically significantly lower than that of B group, respectively, the longest duration of hypopnea of A group and C group was statistically significantly shorter than that of B group, respectively, while the lowest SaO2 of A group and C group was statistically significantly higher than that of B group, respectively （ P 〈 0. 05 ） ; AHI of C group was statistically significantly lower than that of A group, the longest duration of hypopnea of C group was statistically significantly shorter than that of A group （ P 〈 0. 05 ）, while no statistically significant differences of the lowest SaO2 was found between A group and C group （ P 〉 0. 05 ）. No statistically significant differences of plasma NT-proBNP level, LVEF, LVESD or LVEDD was found among the three groups before treatment （P 〉 0. 05）. After treatment, plasma NT-proBNP level, LVESD and LVEDD of B group and C group were statistically significantly lower than those of A group, while LVEF of B group and C group was statistically significantly higher than that of A group, respectively （ P 〈 0. 05 ） ; plasma NT-proBNP level and LVEDD of C group were statistically significantly lower than B group, LVEF of C group was statistically significantly higher than that of B group （ P 〈 0. 05 ） , while no statistically significant differences of LVESD was found between B group and C group （ P 〉 0. 05 ）. No statistically significant differences of PRA, plasma level of Ang Ⅱ or ALD was found among the three groups before treatment （P 〉 0. 05 ）. After treatment, PRA, plasma levels of Ang Ⅱ and ALl） of A group and C group were statistically significantly lower than those of B group （ P 〈 0. 05 ） ; PRA, plasma levels of Ang Ⅱ and ALD of C group were statistically significantly lower than those of A group （ P 〈 0. 05 ）. No statistically significant differences of incidence of adverse reactions was found among the three groups during the treatment （ P 〉 0. 05 ）. Conclusion nCPAP combined with xinmailong injection can effectively improve the ventilation function and cardiac function of heart failure patients complicated with OSAHS, reduce the plasma NT-proBNP level and inhibit the RAAS activity, and is safe.