急性冠脉综合征患者睡眠质量与介入术中慢血流发生的关系及对临床预后的影响

Relationship between sleep quality and slow-flow in patients with acute coronary syndrome during percutaneous coronary intervention and its impact on clinical prognosis

目的探讨经皮冠状动脉介入(PCI)治疗的急性冠脉综合征(ACS)患者住院期间睡眠质量与PCI术中慢血流发生的关系及对临床预后的影响。方法选择2017年1月至2018年10月在广州市第一人民医院心内科住院的ACS的患者200例,患者在择期PCI术前进行匹兹堡睡眠质量指数(PSQI)测定及应用微动敏感床垫式睡眠监测系统(MSMSMS)进行睡眠呼吸监测。按PSQI>7分作为睡眠障碍标准将患者分为正常睡眠组(68例,PSQI≤7分)和睡眠障碍组(132例,PSQI>7分),测定2组患者血浆内皮素-1(ET-1)、一氧化氮(NO)水平,记录PCI术中慢血流发生的情况。对入选病例出院后进行12个月随访,记录住院期间及随访期间不良心血管事件(MACE)的发生情况。结果与正常睡眠组比较,睡眠障碍组患者睡眠呼吸暂停低通气综合征(SAHS)、低氧血症、深睡眠不足的比例更高(25.00%vs 10.29%,25.76%vs 11.76%,66.67%vs 48.53%,均P<0.05),内皮功能指标NO水平更低[(28.65±3.26)μmol/L vs(30.24±4.08)μmol/L,P<0.05],ET-1水平更高[(21.17±3.08)pg/ml vs(18.90±2.95)pg/ml,P<0.05],并且PCI术中发生慢血流/无复流的比例更高(16.67%vs 5.88%,P<0.05);随访12个月,Kaplan-Meier生存分析显示睡眠障碍组ACS患者累积MACE事件数多于睡眠正常组,差异有统计学意义(19.70%vs 7.35%,Log rank=5.06,P=0.025)。结论存在睡眠障碍的ACS患者PCI术中慢血流现象明显增加并影响患者的临床预后。

Objective To investigate the relationship between sleep quality and slow-flow in patients with acute coronary syndrome during percutaneous coronary intervention(PCI)and its impact on clinical prognosis.Methods 200 patients with ACS hospitalized in the cardiology department of Guangzhou First People's Hospital from January 2017 to October 2018 were selected.The Pittsburgh Sleep Quality Index(PSQI)was measured before elective PCI,and the sleep breathing of patients was monitored by micro motion sensitive mattress sleep monitoring system(MSMSMS).The patients were divided into normal sleep group(68 cases,PSQI≤7 points)and sleep disorder group(132 cases,PSQI>7 points).The levels of plasma endothelin-1(ET-1)and nitric oxide(NO)were measured.The"slow-flow"that took place during PCI were also recorded.Major cardiac adverse events(MACE)of patients took placed during 12 months follow-up periods were recorded and compared between two groups.Results Compared with normal sleep group,patients in sleep disorder group had higher ratio of sleep apnea-hypopnea syndrome(SAHS),hypoxemia and lower deep sleep(25.00%vs 10.29%,25.76%vs 11.76%,66.67%vs 48.53%,all P<0.05);lower level of NO and higher level of ET-1[(28.65±3.26)μmol/L vs(30.24±4.08)μmol/L;(21.17±3.08)pg/ml vs(18.90±2.95)pg/ml,P<0.05];more slow-flow events took place during PCI in sleep disorder group than normal sleep group(16.67 vs 5.88%,P<0.05);After 12 months of follow-up,Kaplan-Meier survival analysis showed patients of the two groups had significantly different cumulative non-events survival rates(19.70%vs 7.35%,Log rank=5.06,P=0.025).Conclusions Sleep disorder increase the slow-flow phenomenon during PCI in patients with ACS and affect the clinical prognosis.