医药前沿杂志

摘要  目的：探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome OSAHS)患者心律失常及经鼻持续气道正压通气(n-CPAP)对OSAHS患者心律失常的影响。方法：对因睡眠打鼾就诊并经多导睡眠图(PSG)监测确诊的OSAHS患者90及30例PSG正常的健康体检者，分别行动态心电图(DCG)检测，记录并分析心律失常的类型及次数。对其中16例中重度OSAHS患者在n-CPAP治疗3个月后复查PSG及DCG。结果：重度OSAHS组各型心律失常发生率较对照组升高，以室性早搏、窦性心动过缓明显有统计学意义。中重度OSAHS患者经n-CPAP治疗后心律失常均有减少，室性早搏发生次数较治疗前显著减少(P<0.01)，房性早搏较治疗前减少（P<0.05）。结论：OSAHS患者心律失常较正常人升高，n-CPAP治疗能减少心律失常的发生。
关键词  阻塞性睡眠呼吸暂停； 心律失常； 经鼻持续气道正压通气
【Abstract】  Objective: To investigate the arrhythmia of obstructive sleep apnea hypopnea syndrom (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) on arrhythmia  in patients with OSAHS.  Methods: patients with snoring received polysomnography (PSG), 90 patients diagnosed as OSAHS(OSAHS group) and 30 normal contmls(control group) who had received dynamic cardiography(DCG), Record and analyze the type and frequency of arrhythmia. PSG and DCG were reviewed in 16 patients with moderate-severe OSAHS after 3 months of treatment with n-cpap.Results: The incidence of arrhythmia in severe OSAHS group was higher than that in control group, and the ventricular premature beats and sinus bradycardia were statistically significant.After treatment with n-cpap, arrhythmia in all patients with Moderate-severe OSAHS decreased, the incidence of premature ventricular beats was significantly reduced (P<0.01), and the incidence of premature atrial beats was decreased (P< 0.05). Conclusion: Patients with OSAHS have higher arrhythmia than normal people, and treatment with n-cpap can reduce the occurrence of arrhythmia.
keywords Obstructive sleep apnea; arrhythmia. Nasal continuous positive airway pressure (n-cpap)
 
阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome，OSAHS)是一种常见的临床病症，以睡眠时反复呼吸暂停和低通气为特征,导致间歇低氧和睡眠结构紊乱，出现打鼾、憋气,夜尿增多,晨起头痛,白天嗜睡,记忆力下等临床表现。早期国外资料显示，OSAHS在成年人中的发病率为2%-4%[1]，近年有研究认为OSAHS在成年人中的发病率超过16%[2]。近年来随着研究的不断深入，其伴发的疾病日益受到重视。人们越来越清楚地认识到OSAHS发病的主要环节虽然在上呼吸道，但却会影响到多个器官系统，其中对心血管系统的损害尤为突出，现已证明OSAHS是独立于年龄、体重、饮食、遗传等原因的冠心病发病因素之一,可引起多种心律失常,增加心血管事件发病率和死亡率[3]。目前普遍认为自主神经系统功能紊乱可能是OSAHS导致心血管系统并发症如心律失常的原因之一。

经鼻持续气道内正压通气治疗(n-CPAP)对OSAHS患者的疗效确切，CPAP治疗消除OSAHS患者夜间打鼾及阻塞性呼吸暂停，从而改善低氧血症，纠正高碳酸血症，提高血氧饱和度，改善夜间睡眠质量及日间症状，是目前公推的OSAHS首选治疗手段[4]。但其对OSAHS并发心律失常患者的疗效研究尚不多，本文的目的在于进一步分析OSAHS患者心律失常情况，探讨经鼻持续气道正压通气(nasal continuous positive airway pressure ，nCPAP)对OSAHS患者心律失常影响，为临床诊疗提供理论依据。

来源：医药前沿   只展示部份内容