[经鼻持续气道正压通气（nCPAP）治疗阻塞性睡眠呼吸暂停患者心肺功能参数的改变]

[Modification of cardiopulmonary performance parameters in patients with obstructive sleep apnea treated with nCPAP therapy].

作者信息

Konermann M, Sanner B, Klewer J, Kreuzer I, Laschewski F, Burmann-Urbanek M

机构信息

Medizinischen Universitätsklinik, Ruhr-Universität Bochum, Marten-hospital Herne, Deutschland.

出版信息

Wien Med Wochenschr. 1996;146(13-14):340-3.

PMID:9012176

Abstract

nCPAP influences cardiopulmonary hemodynamic function in patients with obstructive sleep apnea (OSA). It is known that systolic function of the right and left ventricle, systemic and pulmonary hypertension, arterial blood gases and lung function during the day may improve under this treatment. We prospectively followed 30 patients with severe OSA and determined diastolic left ventricular function (Doppler echocardiography), cardiovascular efficiency (steady state exercise stress testing); and individual assessment of performance (standardized psychometric questionnaire) before, and 2 weeks and 6 months after initiation of nCPAP treatment. The following results could be obtained (first value after 2 weeks, second value after 6 months): Doppler echocardiography: E/A rose by 9.3% (p < 0.05) and another 0.5% (n.s.). E/A integral increased by 13.8% (p < 0.01) and another 3.5% (n.s.). Deceleration period decreased by 22.7% (p < 0.01) and another 3.1% (n.s.). Steady state exercise stress testing: Maximum performance rose by 10% (p < 0.05) and another 17.5% (p < 0.01). Heart rate ratio 100 W/rest dropped by 13.5% (p < 0.001) and another 6.5% (p < 0.01), systolic blood pressure ratio 100 W/rest by 0.8% (n.s.) and another 14.9% (p < 0.001). Diastolic blood pressure ratio 100 W/rest did not change significantly. Questionnaire: Assessment of well-being increased by 44.5% (p < 0.05) and another 16.9% (n.s.). After an initial drop of 0.8% (n.s.), quality of life increased by 14.9% (p < 0.05). Assessment of performance rose by 21.7% (p < 0.05) and another 4.1% (n.s.). nCPAP therapy in patients with OSA improves diastolic function of the left ventricle, cardiovascular performance and individual assessment of performance.

摘要

无创持续气道正压通气（nCPAP）会影响阻塞性睡眠呼吸暂停（OSA）患者的心肺血流动力学功能。已知在这种治疗下，左右心室的收缩功能、系统性和肺动脉高压、白天的动脉血气和肺功能可能会得到改善。我们前瞻性地跟踪了30例重度OSA患者，并在开始nCPAP治疗前、治疗2周后和6个月后分别测定了左心室舒张功能（多普勒超声心动图）、心血管效率（稳态运动负荷试验）以及个体表现评估（标准化心理测量问卷）。可得出以下结果（2周后的第一个数值，6个月后的第二个数值）：多普勒超声心动图：E/A升高了9.3%（p<0.05），之后又升高了0.5%（无统计学意义）。E/A积分升高了13.8%（p<0.01），之后又升高了3.5%（无统计学意义）。减速期降低了22.7%（p<0.01），之后又降低了3.1%（无统计学意义）。稳态运动负荷试验：最大运动能力提高了10%（p<0.05），之后又提高了17.5%（p<0.01）。心率比（100瓦运动时/静息时）降低了13.5%（p<0.001），之后又降低了6.5%（p<0.01），收缩压比（100瓦运动时/静息时）降低了0.8%（无统计学意义），之后又降低了14.9%（p<0.001）。舒张压比（100瓦运动时/静息时）无显著变化。问卷：幸福感评估提高了44.5%（p<0.05），之后又提高了16.9%（无统计学意义）。在最初下降0.8%（无统计学意义）之后，生活质量提高了14.9%（p<0.05）。表现评估提高了21.7%（p<0.05），之后又提高了4.1%（无统计学意义）。OSA患者的nCPAP治疗可改善左心室舒张功能、心血管表现及个体表现评估。