阻塞性睡眠呼吸暂停低通气综合征手术前后采用超声监测心功能参数变化及其对疗效的评估价值

Changes in cardiac function parameters monitored by ultrasound before and after surgery for obstructive sleep apnea hypoventilation syndrome and its value in assessing the outcome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)手术前后采用超声监测心功能参数变化及临床意义,并分析其对疗效的评估价值,以期为临床制定后续干预方案提供依据。方法选取2019年1月至2020年12月河北省人民医院收治的OSAHS患者60例作为观察组,另选取同期健康体检者60例作为对照组。比较两组心功能参数[左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、二尖瓣舒张早期峰值血流速度(E)/二尖瓣舒张晚期血流速度(A)、Tei指数]水平,观察组均行手术治疗,根据治疗效果分为有效患者与无效患者,比较不同疗效患者手术前后心功能参数,评价心功能参数变化差值对疗效的评估价值。结果观察组LVEDd、LVESd、Tei指数大于对照组,LVEF、LVFS、E/A低于对照组(P<0.05);Pearson相关性分析,LVEDd、LVESd、Tei指数与OSAHS呈正相关(r=0.522、0.573、0.514),LVEF、LVFS、E/A与OSAHS呈负相关(r=-0.509、-0.410、-0.478,P<0.05);术后3个月有效患者LVEDd、LVESd、Tei指数低于术前及无效患者,LVEF、LVFS、E/A高于术前及无效患者(P<0.05);观察组有效患者LVEDd、LVESd、Tei指数、LVEF、LVFS、E/A术前与术后3个月变化差值>无效患者(P<0.05);Pearson相关性分析,LVEDd、LVESd、Tei指数、LVEF、LVFS、E/A术前与术后3个月变化差值与疗效呈正相关(r=0.508、0.517、0.554、0.396、0.427、0.461,P<0.05);ROC曲线显示,LVEDd、LVESd、Tei指数、LVEF、LVFS、E/A术前与术后3个月变化差值评估疗效的AUC分别为0.739、0.756、0.771、0.819、0.827、0.733,联合评估疗效AUC为0.922,优于各参数单独评估。结论超声监测心功能参数变化可有效评估OSAHS患者术后疗效,为临床术前评估心功能受损程度、术后评估心功能改善程度提供参考,以针对性制定相应干预方案。

Objective To investigate the changes of cardiac function parameters and the clinical significance of using ultrasound monitoring before and after surgery for obstructive sleep apnea hypoventilation syndrome(OSAHS).Methods Sixty patients with OSAHS from January 2019 to December 2020 in Hebei Provincial People’s Hospitalwere selected as the observation group,and another 60 patients with healthy physical examination during the same period were selected as the control group.The levels of cardiac function parameters[left ventricular end-diastolic internal diameter(LVEDd),left ventricular end-systolic internal diameter(LVESd),left ventricular ejection fraction(LVEF),left ventricular short-axis shortening rate(LVFS),mitral valve early diastolic peak flow velocity(E)/late mitral valve diastolic flow velocity(A),and Tei index]were compared between the two groups,and the observation group was treated surgically and divided into the effective patients and ineffective patients;the cardiac function parameters were compared before and after surgery in the patients with different efficacy;and the value of the difference in the change of cardiac function parameters on the assessment of efficacy was evaluated.Results The indices of the LVEDd,LVESd and Tei in the observation group were higher than those in the control group,while the indices of the LVEF,LVFS and E/A in the observation group was lower than those in the control group(P<0.05).Pearson correlation analysis showed that LVEDd,LVESd and Tei index were positively correlated with OSAHS(r=0.522,0.573,0.514),while LVEF,LVFS and E/A were negatively correlated with OSAHS(r=-0.509,-0.410,-0.478,P<0.05).Three months after operation,LVEDd,LVESd and Tei indices of the effective patients were lower than those of the preoperative and ineffective patients,while LVEF,LVFS and E/A were higher than those of the preoperative and ineffective patients(P<0.05).The difference values of LVEDd,LVESd,Tei index,LVEF,LVFS and E/A between the preoperative and postoperative 3 months in the observation group were higher than those in the ineffective patients(P<0.05).Pearson correlation analysis showed that the differences of LVEDd,LVESd,Tei index,LVEF,LVFS,E/A between the preoperative and postoperative 3 months were positively correlated with the curative effect(r=0.508,0.517,0.554,0.396,0.427,0.461,P<0.05).ROC curve showed that the differences of LVEDd,LVESd,Tei index,LVEF,LVFS and E/A between the preoperative and postoperative 3 months after the surgery were 0.739,0.756,0.771,0.819,0.827,0.733,respectively;and the AUC of combined evaluation was 0.922 and it was better than the individual evaluation of the each parameter.Conclusion Ultrasonic monitoring of changes in the cardiac function parameters can effectively evaluate postoperative efficacy of the patients with OSAHS and provide reference for the preoperative evaluation of cardiac function impairment and postoperative evaluation of cardiac function improvement so as to formulate corresponding intervention programs.