NPPV对舒张型心功能不全合并阻塞性睡眠呼吸暂停低通气综合征患者的脑钠肽水平及左心室功能变化的影响

Effect of NPPV on brain natriuretic peptide level and left ventricular function in patients with diastolic cardiac insufficiency complicated with obstructive sleep apnea hypopnea syndrome

摘要:

目的 分析无创正压通气（NPPV）对舒张型心功能不全合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者脑钠肽（BNP）水平及左心室功能变化的影响。方法 选取北京大学国际医院2018年5月—2020年5月收治的148例舒张型心功能不全合并OSAHS患者作为研究对象，按照随机数字表法分为常规组与NPPV组，每组74例。常规组采用常规药物治疗，NPPV组在常规组治疗基础上加用NPPV治疗。比较两组的临床疗效、左心室功能、睡眠指标、血气指标、血清因子。结果 NPPV组治疗总有效率（97.30%）与常规组（93.24%）比较，差异无统计学意义（P >0.05）；NPPV组治疗后左室射血分数（LVEF）高于常规组，左室收缩末期内径（LVESD）及左室舒张末期内径（LVEDD）及睡眠呼吸暂停低通气指数（AHI）、微觉醒指数（MAI）、Epworth嗜睡量表（ESS评分）低于常规组（P <0.05）；NPPV组治疗后动脉血氧分压（PaO₂）高于常规组，动脉血二氧化碳分压（PaCO₂）、氧减饱和度指数（ODI）、BNP、C反应蛋白（CRP）、肌钙蛋白I（cTnI）低于常规组（P <0.05）。结论 NPPV治疗舒张型心功能不全合并OSAHS的效果显著，能够改善患者缺氧状态及左心室功能，提高夜间睡眠质量，降低BNP水平，抑制炎症反应。

Abstract:

Objective To analyze the effects of non-invasive positive pressure ventilation (NPPV) on brain natriuretic peptide (BNP) and left ventricular function in patients with diastolic cardiac insufficiency (DHF) complicated with obstructive sleep apnea hypoventilation syndrome (OSAHS).Methods From May 2018 to May 2020, 148 patients with DHF complicated with OSAHS treated in Peking University International Hospital were selected as the research object. They were randomly divided into routine group and NPPV group, with 74 cases in each group. The routine group was treated with routine drugs, and the NPPV group was treated with NPPV. The clinical efficacy, left ventricular function, sleep index, blood gas index, and serum factors were compared between the two groups.Results There was no significant difference in the total effective rate between NPPV group (97.30%) and routine group (93.24%) (P > 0.05). After treatment, LVEF in NPPV group was higher than that in routine group, and the scores of LVESD, LVEDd, AHI, Mai, and ESS in NPPV group were lower than those in routine group (P < 0.05); PaO₂ in NPPV group was higher than that in routine group, while PaCO₂, ODI, BNP, CRP and cTnI were lower than those in routine group (P < 0.05).Conclusions DHF with OSAHS is effectively treated with NPPV, which can improve hypoxia and left ventricular function, improve night sleep quality, reduce BNP level, and inhibit inflammatory response.