无创正压通气对冠心病合并阻塞性睡眠呼吸暂停综合征心律失常和心功能的影响

Effect of non-invasive positive pressure ventilation on arrhythmia and heart function in patients with coronary heart disease complicated with obstructive sleep apnea hypopnea syndrome

目的探讨冠心病合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者采用无创正压通气治疗的疗效。方法选取2014-06至2015-06医院接收的冠心病合并OSAHS患者86例,随机分为对照组与观察组,每组43例。对照组常规治疗,观察组采用无创正压通气,对比分析治疗后两组心律失常的相关指标变化情况。结果治疗后,观察组Low Sa O2(由89.5±3.1升至94.5±4.5)显著升高,AHI显著降低(由9.8±3.2降至1.6±0.4),TST Sa O2<90%显著降低(从58.8±6.3降至18.5±6.5),左心室收缩末期内径、左室舒张末期内径、夜间最快心率、室上性心律失常次数显著降低;左室射血分数、夜间最慢心率显著升高,血气分析、心脏彩超、动态心电图指标均显著改善,优于对照组,差异有统计学意义(P<0.05)。结论采用无创机械通气治疗冠心病合并OSAHS患者可有效改善患者血气指标,减少心律失常,纠正夜间低氧血症,改善心功能,具有推广价值。

Objective To investigate the efficacy of non-invasive positive pressure ventilation in patients with coronary heart disease complicated with obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods Eighty-six patients with coronary heart disease（ CHD） complicated with obstructive sleep apnea hypopnea syndrome（ OSAHS） admitted to our hospital between June 2014 and June 2015 were randomly divided into the control group（ standard treatment,n = 43） and the observation group（ standard treatment plus non-invasive positive pressure ventilation,n = 43） to observe the impact of clinical treatment on arrhythmia. Results After treatment,the observation group saw remarkable changes in the following indicators： significant increase of Low Sa O2（ from 89. 5 ± 3. 1 to94. 5 ± 4. 5）,apparent decrease of both AHI（ from 9. 8 ± 3. 2 to 1. 6 ± 0. 4） and TST Sa O2〈90%（ from 58. 8 ± 6. 3 to 18. 5 ± 6. 5）,lowered left ventricular end systolic internal diameter（ from 37. 5 ± 2. 3 to 35. 0 ± 1. 5）,lowered end diastolic internal diameter（ from49. 2 ± 3. 6 to 45. 1 ± 3. 2）,increased left ventricular ejection fractions（ LVEF）（ from 0. 52 ± 0. 05 to 0. 59 ± 0. 05）,lowered maximum nighttime heart rate（ from 105. 6 ± 12. 3 to 87. 5 ± 9. 7） and higher minimum nighttime heart rate（ from 47. 5 ± 8. 3 to 62. 5 ±6. 3）. An apparent decrease was also found in supraventricular arrhythmias（ from 915. 5 ± 97. 4 to 213. 2 ± 50. 3） and ventricular arrhythmias（ from 483. 2 ± 50. 4 to 107. 2 ± 30. 9）. The above indicators of blood gas,echocardiography and dynamic electrocardiograms were all remarkably improved in the observation group compared with the control group（ P〈0. 05）. Conclusions The use of noninvasive mechanical ventilation in the treatment of coronary heart disease complicated with OSAHS can effectively improve patients＇ blood gas indicators,reduce arrhythmia,correct nocturnal hypoxemia and improve heart function,so this approach is worthy of wide clinical application.