无创正压通气治疗中枢性睡眠呼吸暂停 合并心力衰竭的疗效研究

Effect of continuous positive airway pressure on adverse events in patients with acute decompensated heart failure and central sleep apnea during nighttime hospitalization

摘要:

目的 探讨无创正压通气（CPAP）对急性失代偿性心力衰竭（ADHF）合并中枢性呼吸睡 眠暂停（CSA）患者夜间住院期间不良事件的影响。方法 回顾性队列研究2014 年1 月—2016 年12 月 在温州医科大学附属台州医院诊治的ADHF 合并CSA 的78 例患者临床资料，根据是否使用CPAP 将患者分 为CPAP 组48 例和非CPAP 组30 例。主要观察指标为住院期间夜间不良事件，包括急性心力衰竭（以下简 称心衰）发作、心律失常（包括窦性心动过缓、房- 室传导阻滞）及猝死。结果 两组患者入院时的年龄、 性别、体重指数、既往病史中高血压、高脂血症及陈旧心梗病史等临床资料比较，差异无统计学意义（P <0.05）； CPAP 组氨基末端脑钠肽前体较非CPAP 组高（P <0.05）。两组患者夜间急性心衰发作比较，差异有统计学意 义（P <0.05）；而两组夜间心率失常和猝死比较，差异无统计学意义（P >0.05）。结论 CPAP 可降低ADHF 合并CSA 患者住院期间夜间急性心衰发作的概率，但对心率失常和猝死未见效果。

Abstract:

Objective To investigate the effect of continuous positive airway pressure (CPAP) on adverse events during nighttime hospitalization in patients with acute decompensated heart failure (ADHF) and central sleep apnea (CSA). Methods This was a retrospective cohort study. The clinical data of ADHF patients with CSA treated in Taizhou Hospital of Zhejiang Province from January 2014 to December 2016 were selected and divided into two groups according to whether CPAP was used. The main outcome measures were nocturnal adverse events during hospitalization, defined as acute heart failure, arrhythmia (including sinus bradycardia, atrioventricular block), sudden death. Results There was no significant difference in age, sex, BMI, hypertension, hyperlipidemia and previous MI history between the two groups at admission (P < 0.05). The NT-pro BNP in group CPAP was higher than that in non-CPAP group (P < 0.05). The primary endpoint of nocturnal adverse events was lower in CPAP group (P < 0.05), which was mainly contributed by acute heart failure during night (P < 0.05). There was no significant difference in arrhythmia and sudden death rate between the two groups at night (P > 0.05). Conclusions CPAP can reduce the incidence of nighttime acute heart failure in ADHF patients with CSA, but has no obvious effect on arrhythmia and sudden death.