经鼻面罩持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者血压的影响

摘要

Objective To analyze the effects of long term nasal continuous positive airway pressure on the blood pressure of patients with OSAHS.Methods From April 1997 to October 2008,2898 patients from the First Affiliated Hospital of Fujian Medical University who complained snore during sleeping were studied.Nine hundred eighty cases were diagnosed as OSAHS with hypertension,and these patients were randomly divided into 2 groups:one group was treated with antihypertensive drugs and nasal continuous positive airway pressure (nCPAP), while the other group only received antihypertensive drugs.The polysomnography(PSG) was recorded during sleeping and the blood pressure was remeasured after 6 months or more. All patients were followed up for 5 years to observe the long-term effects of nCPAP or drugs.Results Systolic and diastolic blood pressure in the nCPAP group significantly decreased after 6 months [(125±16)mmHg (1 mm Hg=0.133 kPa) vs (136±19)mm Hg,(83 ±10)mm Hg vs (95 ±15)mmHg,P ＜ 0.05 ],and the decreasing extent of blood pressure in nCPAP group was more notable than antihypertensive drug group [ decreasing extent of systolic blood pressure:( 10 ± 11 )mm Hg vs (4 ± 11 )mmHg ; decreasing extent of diastolic blood pressure:( 11 ± 7 )mm Hg vs ( 6 ± 7 )mm Hg; P ＜ 0.05 ].The total effective rate in nCPAP group was significantly higher than that in antihypertensive drug group (90％ vs 38％,P ＜0.01).One hundred and eighty three cases in nCPAP group and 157 cases in antihypertensive drug group completed the 5-year follow-up and the blood pressure was controlled within the normal range.Some patients could gradually reduce or stop the use of antihypertensive drugs and the blood pressure didn' t appear to rebound. The number of antihypertensive drugs in the nCPAP group was significantly fewer as compared to the antihypertensive drugs group after 2,3,4 and 5 years' follow-up.Conclusions nCPAP is a safe and effective treatment for high blood pressure in patients witb OSAHS.%目的 分析经鼻面罩持续气道正压通气( nCPAP)治疗对OSAHS合并高血压患者血压的影响.方法 分析从1997年4月至2008年10月福建医科大学附属第一医院门诊及病房收治的主诉睡眠打鼾患者2898例,其中男2467例,女431例,年龄27 ～ 73岁,平均(47±9)岁.其中确诊OSAHS合并高血压 980例,按随机数字表法分为2组,每组490例,A组口服降压药并进行nCPAP治疗,B组单纯口服降压药,均持续6个月以上,复查PSG监测和血压.两组均继续随访至5年,观察长期疗效.结果 6个月后A组的收缩压[(95±15)mm Hg(1 mm Hg =0.133 kPa)]和舒张压[(83±10)mm Hg]较治疗前[(125±16)mm Hg、(136±19)mm Hg]明显降低(P＜0.05),其中收缩压下降(10±11) mm Hg,舒张压下降(11 ±7)mmHg,B组分别为(4±11)mm Hg和(6 ±7)mm Hg,A组高血压改善幅度明显优于B组(均P ＜0.05).两组中分别有183例和157例完成了5年随访,血压均控制满意,部分患者逐渐减少甚至停用降压药后未出现血压反弹,第2年后每年随访时A组服用高血压药物种类较单纯服药组明显减少.结论 nCPAP是内科治疗OSAHS合并高血压患者安全有效的方法.