无创正压气道通气对老年脑梗死并阻塞性睡眠呼吸暂停患者预后的影响

Effect of continuous positive airway pressure on ambulatory blood pressure and cardio-cerebrovascular events in elderly OSA patients

目的探讨无创正压气道通气(CPAP)对老年脑梗死合并阻塞性睡眠呼吸暂停(OSA)患者24h动态血压和心脑血管事件的影响,并分析影响不良心脑血管事件的危险因素。方法选择鞍钢集团总医院2012年5月~2015年5月收治的老年脑梗死合并OSA患者145例,按照随机数字表分为治疗组(CPAP治疗)73例和对照组72例。评估2组患者24h动态血压,随访1年时,用Kaplan-Meier生存曲线评价2组的生存情况,采用ROC曲线分析预测心脑血管事件发生的危险因素。结果出院前2组24h收缩压、24h舒张压、昼间收缩压、昼间舒张压、夜间舒张压均有显著差异(P<0.05)。随访1年时,Kaplan-Meier生存曲线显示,治疗组与对照组中位生存时间无显著差异(365dvs 362d,P>0.05),治疗组心脑血管事件发生率显著低于对照组(21.9%vs 33.3%,P<0.05)。ROC曲线显示,睡眠呼吸暂停指数的曲线下面积为0.70(95%CI:0.61~0.77,P=0.002)和24h收缩压的曲线下面积为0.72(95%CI:0.63~0.81,P=0.003),两者为预测心脑血管事件发生的危险因素。结论 CPAP能有效降低老年脑梗死合并OSA患者24h动态血压,降低心脑血管事件发生率。

Objective To study the effect of continuous positive airway pressure（CPAP）on 24 h ambulatory blood pressure（ABP）and cardiao-cerebrovascular events（CCE）in elderly ischemic stroke patients with OSA and analyze the risk factors for CCE.Methods One hundred and fortyfive elderly ischemic stroke patients aged 60-80（68.5±7.3）years admitted to our hospital from May 2012 to May 2015 were randomly divided into CPAP group（n=73）and control group（n=72）.Their 24 hABP was measured.The patients were followed up for 1year.Their survival time was analyzed by Kaplan-Meier survival analysis.The risk factors for CCE were predicted according to their ROC curve.Results The 24 hSBP and DBP,day SBP and DBP,and night DBP were significantly different between the two groups before discharge（P〈0.05）.Kaplan-Meier survival analysis showed no significant difference in survival time between the two groups（365dvs 362 d,P〈0.05）.The incidence of CCE was significantly lower in CPAP group than in control group（21.9%vs 33.3%,P〈0.05）.The area under the ROC curve for AHI and 24hSBP（0.70,95%CI：0.61-0.77,P=0.002;0.72,95%CI：0.63-0.81,P=0.003）were the risk factors for CCE.Conclusion CPAP can effectively reduce the 24 hABP and the incidence of CCE in elderly ischemic stroke patients with OSA.