双水平无创正压通气辅助治疗对慢性心力衰竭合并睡眠呼吸暂停综合征患者血管内皮功能及心肺功能的影响

摘要

目的：探讨双水平无创正压通气（BiPAP）辅助治疗对慢性心力衰竭（CHF）合并睡眠呼吸暂停综合征（SAS）患者血管内皮功能及心肺功能的影响。方法选取2012年1月—2015年1月中国人民解放军海军安庆医院收治的 CHF 合并 SAS 患者250例，按照随机数字表法分为对照组和观察组，各125例。对照组患者采用最优药物治疗，观察组患者在对照组基础上给予 BiPAP 辅助治疗，两组患者均治疗4周。比较两组患者临床疗效及治疗前后血管内皮功能指标、心肺功能指标、动脉血气分析指标，出院1个月后进行电话随访，记录患者终点事件发生情况。结果观察组患者临床疗效优于对照组（P ＜0.05）。治疗前两组患者血清一氧化氮（NO）、内皮素（ET）、血管性假血友病因子（vWF）水平及肱动脉内径变化率（ΔD）比较，差异无统计学意义（P ﹥0.05）；治疗后观察组患者血清 NO 水平和ΔD 高于对照组，血清 ET 和 vWF 水平低于对照组（P ＜0.05）。治疗前两组患者左心室射血分数（LVEF）和血浆脑钠肽水平比较，差异无统计学意义（P ﹥0.05）；治疗后观察组患者 LVEF 高于对照组，血浆脑钠肽水平低于对照组（P ＜0.05）。治疗前两组患者第1秒用力呼气容积（FEV1）、用力肺活量（FVC）及 FEV1/ FVC 比较，差异无统计学意义（P ﹥0.05）；治疗后观察组患者 FEV1、FVC 及 FEV1/ FVC 高于对照组（P ＜0.05）。两组患者治疗前后 pH 值及治疗前动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）比较，差异无统计学意义（P ﹥0.05）；治疗后观察组患者 PaCO2低于对照组，PaO2和 SaO2高于对照组（P ＜0.05）。随访期间观察组患者终点事件发生率低于对照组（P ＜0.05）。结论 BiPAP 辅助治疗 CHF 合并 SAS 的临床疗效确切，能有效改善患者血管内皮功能、心肺功能及预后。%Objective To investigate the impact of BiPAP on vascular endothelial function and cardio - pulmonary function of chronic heart failure( CHF) patients complicated with sleep apnea syndrome( SAS). Methods A total of 250 CHF patients complicated with SAS were selected in Anqing Naval Hospital of Chinese People′s Liberation Army from January 2012 to January 2015,and they were divided into control group and observation group according to random number table,each of 125 cases. Patients of both groups were given the optimal drug therapy after admission,while patients of observation group were given extra BiPAP for adjuvant treatment;both groups continuously treated for 4 weeks. Clinical effect,index of vascular endothelial function,cardio - pulmonary function and arterial blood - gas analysis before and after treatment were compared between the two groups;patients of both groups were followed up for 1 month by telephone to observe the incidence of endpoint events. Results The clinical effect of observation group was statistically significantly better than that of control group( P <0. 05). No statistically significant differences of serum level of NO,ET,vWF or change rate of brachial artery diameter was found between the two groups before treatment(P ﹥ 0. 05);after treatment,serum NO level and change rate of brachial artery diameter of observation group were statistically significantly higher than those of control group,while serum levels of ET and vWF of observation group were statistically significantly lower than those of control group( P < 0. 05). No statistically significant differences of LVEF or plasma BNP level was found between the two groups before treatment(P ﹥ 0. 05);after treatment,LVEF of observation group was statistically significantly higher than that of control group,while plasma BNP level of observation group was statistically significantly lower than that of control group(P < 0. 05). No statistically significant differences of FEV1 ,FVC or FEV1 / FVC was found between the two groups before treatment(P ﹥ 0. 05);while FEV1 ,FVC and FEV1 / FVC of observation group were statistically significantly higher than those of control group after treatment( P < 0. 05). No statistically significant differences of pH,PaCO2 ,PaO2 or SaO2 was found between the two groups before treatment,nor was pH between the two groups after treatment(P ﹥ 0. 05);after treatment,PaCO2 of observation group was statistically significantly lower than that of control group,while PaO2 and SaO2 of observation group were statistically significantly higher than those of control group(P < 0. 05). The incidence of endpoint events during follow - up of observation group was statistically significantly lower than that of control group(P < 0. 05). Conclusion BiPAP has certain clinical effect in the adjuvant treatment of CHF patients complicated with SAS,can effectively improve the vascular endothelial function,cardio - pulmonary function and prognosis.