阻塞性睡眠呼吸暂停低通气综合征合并COPD患者右心室收缩功能分析

Analysis of right ventricular systolic function in patients with obstructive sleep apnea hypopnea syndrome complicated with COPD

目的通过分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并慢性阻塞性肺疾病(COPD)患者右心室收缩功能,为临床诊断及治疗提供帮助.方法收集天津市滨海新区中医医院内科住院治疗的OSAHS患者共计96例,根据是否合并COPD分为OSAHS组(48例)、OSAHS+COPD组(48例),另收集48例自愿参加试验的健康成年人作为对照组.采用VINNO 70彩色多普勒超声诊断仪测量3组患者的肺动脉收缩期压力,三尖瓣环收缩期峰值位移,右心室面积变化率,右心室游离壁心尖段、中间段及基底段收缩期峰值速度(Vs),收缩期峰值应变(S),收缩期峰值应变率(SRs),分析所得数据的差异性.结果 3组患者年龄、心率及血压数据比较,差异均无统计学意义(P值均>0.05);OSAHS+COPD组体质量指数明显高于对照组(t=3.450,P<0.05);对照组呼吸暂停低通气指数低于OSAHS组、OSAHS+COPD组(F=5.696,P<0.05),最低动脉血氧饱和度高于OSAHS组、OSAHS+COPD组(F=14.201,P<0.05).OSAHS+COPD组患者肺动脉收缩压高于对照组及OSAHS组(F=4.332,P<0.05),三尖瓣瓣环收缩期峰值位移、右心室面积变化率均低于对照组及OSAHS组(F=6.519、8.018,P值均<0.05).OSAHS组及OSAHS+COPD组右心室游离壁基底段、中间段、心尖段Vs、S、SRs均低于对照组(P值均<0.05),OSAHS+COPD组基底段、中间段、心尖段Vs、S均低于OSAHS组(P值均<0.05),余参数组间比较差异均无统计学意义(P值均>0.05).结论 OSAHS及OSAHS合并COPD的患者右心室收缩功能均有一定程度降低,且OSAHS合并COPD患者右心室功能降低更明显.

Objective To assist in the diagnosis and treatment of patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) combined with right ventricular systolic function in patients with chronic obstructive pulmonary diseases (COPD) .Methods A total of 96 patients with OSAHS who were admitted to the Tianjin Binhai New Area Chinese Medicine Hospital for medical treatment were divided into OSAHS group ( 48 cases) ,OSAHS+ COPD group (48 cases) ,and 48 healthy adults who volunteered to participate in the trial were collected as control group .Pulmonary arterial systolic pressure ,tricuspid annulus systolic peak displacement ,right ventricular area change rate ,and systolic peak velocity ( Vs) ,systolic peak strain ( S) and systolic peak strain rate ( SRs) in apical ,middle and basal segments of the right ventricular free wall were measured using a VINNO 70 color Doppler ultrasound system .Analyze the difference in the data obtained .Results There were no significant differences in the age ,heart rate and blood pressure among the three groups ( all P >0 .05) .The body mass index of the OSAHS+COPD group was significantly higher than that of the control group ( t =3 .435 , P <0 .05) .The apnea hypopnea index in the OSAHS group and the OSAHS+COPD group was significantly higher than that in the control group ( F =5 .696 , P <0 .05) ,and the lowest arterial oxygen saturation in the control group was lower than that in the OSAHS group and the OSAHS + COPD group ( F = 14 .201 , P < 0 .05) .Pulmonary arterial systolic pressure was higher in the OSAHS + COPD group than that in the control group and OSAHS group ( F =4 .332 , P < 0 .05) ,the peak position of the tricuspid annulus and the right ventricular area change rate were lower in the OSAHS +COPD group than that in the control group and OSAHS group ( F = 6 .519 ,8 .018 ,both P < 0 .05) .The right ventricular basal segment , middle segment ,apical segment Vs ,S ,SRs in OSAHS group and OSAHS + COPD group were lower than those in the control group ( all P <0 .05);the Vs ,S ,SRs of the basal segment ,middle segment and apical segment in OSAHS+COPD group were lower than those in the OSAHS group ( all P < 0 .05 ) .There was no significant difference among the remaining parameters ( all P >0 .05) .Conclusions Patients with OSAHS and OSAHS combined with COPD had a lower degree of right ventricular systolic function .The right ventricular function was significantly lower in OSAHS patients with COPD .