持续气道正压通气治疗妊娠期合并中重度阻塞性睡眠呼吸暂停低通气综合征的效果研究

Study on the value of continuous positive airway pressure therapy in patients with moderate to severe obstructive sleep apnea hypopnea syndrome during pregnancy

目的研究持续气道正压通气(CPAP)治疗妊娠期合并中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床效果。方法选取90例妊娠期合并OSAHS患者,依据奇偶数分组法将患者分为研究组与对照组,各45例。对照组采取常规治疗,研究组在常规基础上采用CPAP治疗。比较两组治疗前后通气相关指标、心率变异性指标及睡眠质量评分。结果治疗前,两组呼吸暂停通气指数(AHI)、平均血氧饱和度(平均SaO_(2))、夜间最低血氧饱和度(最低SaO_(2))及C反应蛋白(CRP)水平比较,差异无统计学意义(P>0.05);治疗后,研究组AHI指标低于对照组,平均SaO_(2)及最低SaO_(2)高于对照组,CRP水平(7.46±1.26)mg/L低于对照组(10.38±1.37)mg/L,差异有统计学意义(P<0.05)。治疗前,两组24h每5分钟平均窦性R-R间期标准差(SDANN)、24h窦性R-R间期总体标准差(SDNN)、相邻R-R问期差值>50ms百分比(PNN50)及相邻窦性R-R间期差值的均方根(rMssD)指标比较,差异无统计学意义(P>0.05);治疗后,研究组rMssD、PNN50、SDNN及SDANN指标均高于对照组,差异有统计学意义(P<0.05)。治疗前,两组睡眠质量各项评分比较,差异无统计学意义(P>0.05);治疗后,研究组睡眠质量各项评分均低于对照组,差异有统计学意义(P<0.05)。结论在妊娠期OSAHS患者的临床治疗中,采用CPAP,可有效改善患者的通气功能,提高其睡眠质量,改善心率变异性指标,效果显著,值得临床借鉴。

Objective To investigate the efficacy of continuous positive airway pressure(CPAP)in the treatment of moderate to severe obstructive sleep apnea hypopnea syndrome(OSAHS)during pregnancy.Methods 90 pregnant patients complicated with OSAHS were selected and divided into study group and control group according to odd and even grouping method,with 45 cases in each group.The control group received routine treatment,and the study group received CPAP treatment on a routine basis.Ventilator-related indexes,heart rate variability indexes and sleep quality scores were compared between the two groups before and after treatment.Results Before treatment,there were no significant differences in apnea ventilation index(AHI),mean blood oxygen saturation(SaO_(2)),nocturnal minimum blood oxygen saturation(SaO_(2)) and C-reactive protein(CRP)levels between 2 groups(P>0.05).After treatment,the AHI index of the study group was lower than that of the control group,the average SaO_(2) and the lowest SaO_(2) were higher than that of the control group,and the CRP level was lower than that of the control group(7.46±1.26)mg/L(10.38±1.37)mg/L(P<0.05).Before treatment,the mean standard deviation of sinus R-R interval(SDANN)every 5 minutes for 24 h,the overall standard deviation of sinus R-R interval(SDNN)for 24 h,the percentage of adjacent R-R interval difference>50 ms(PNN50),and the root mean square(rMssD)of adjacent sinus R-R interval difference were compared between the two groups.There was no significant difference(P>0.05).After treatment,the rMssD,PNN50,SDNN and SDANN indexes of the study group were higher than those of the control group,and the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in sleep quality scores between the two groups(P>0.05).After treatment,scores of sleep quality in the study group were lower than those in the control group,with statistical significance(P<0.05).Conclusion In the clinical treatment of pregnant PATIENTS with OSAHS,the use of CPAP can effectively improve the ventilation function,sleep quality and heart rate variability index of patients,and the effect is significant,which is worthy of clinical reference.