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PCI对OSAHS患者呼吸调控稳定性的影响

赵晓赟,赵芳,张力,李冠华,李月川   

  1. 天津市胸科医院胸内科
  • 收稿日期:2012-09-12 修回日期:2012-11-25 出版日期:2013-05-15 发布日期:2013-05-15
  • 通讯作者: 赵晓赟

Affect of percutaneous coronary intervention on the instability of respiratory regulation in OSAHS patients

ZHAO XIAO YUN1,ZHAO FANG1,ZHANG LI1,LI GUAN HUA1,LI YUE CHUAN   

  • Received:2012-09-12 Revised:2012-11-25 Published:2013-05-15 Online:2013-05-15
  • Contact: ZHAO XIAO YUN

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摘要：

【摘要】 目的 研究冠心病经皮冠状动脉介入治疗(PCI)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸调控稳定性的影响。方法 按就诊时间顺序选取经多导睡眠监测(PSG)确诊为OSAHS(呼吸暂停低通气指数AHI≥5),但未接受持续气道正压(CPAP)通气或手术治疗的冠心病患者41例,采用病例自身对照法分别在PCI术前、术后3d、术后1个月进行PSG、血清学及超声心动图检查,收集相关临床资料并进行比较。结果 患者的血清学检验、超声心动图检查等临床资料在PCI术后3d及1个月与术前相比较差异均无统计学意义。而中枢性睡眠呼吸暂停指数(CSAI)、混合性睡眠呼吸暂停指数(MSAI)和微觉醒指数(MAI)在PCI术后3d较术前显著升高(P<0.01),术后1个月较术后3d又显著下降(P<0.01),与术前水平相比差异无统计学意义。结论 冠心病PCI可能引起OSAHS患者短暂性的呼吸调控功能不稳定和交感神经兴奋性增高,表现为患者在睡眠时中枢性睡眠呼吸暂停(CSA)、混合性睡眠呼吸暂停(MSA)、微觉醒事件一过性增加,但具有自限性。 

关键词: 血管成形术, 经腔, 经皮冠状动脉, 睡眠呼吸暂停, 中枢性, 睡眠呼吸暂停, 阻塞性, 呼吸中枢

Abstract: Objective  To investigate whether percutaneous coronary intervention（PCI）causes instability of the respiratory regulation in patients of coronary heart disease with obstructive sleep apnea-hypopnea syndrome(OSAHS). Method   The author conducted a prospective self-control study in which 41 cases were involved by admission order who suffered coronary heart disease with OSAHS, and follow-up treated with PCI. Polysomnograph, echocardiogram and serum test performed not only ahead of PCI but also 3 days and 1 month after PCI respectively. All patients had never been treated with constant positive airway pressure (CPAP) ventilation or any type of operation during the study. Result   There was no significant change in echocardiogram and serum test outcome of the patients throughout our study (P>0.05). The central sleep apnea index(CSAI), the mixed sleep apnea index(MSAI) and the micro-arousal index (MAI) had increased significantly in 3 days after PCI(P<0.01), and then decreased to preoperative levels 1 month later(P<0.01). Conclusion  PCI may provoke transient instability of central respiratory regulation, and increase sympathetic activity, which caused more CSA, MSA and micro-arousal events during sleep periods.

Key words: angioplasty, transluminal, percutaneous coronary, sleep apnea, central, sleep apnea, obstructive, 呼吸中枢