阻塞性睡眠呼吸暂停综合征与脑梗死后遗症患者心率变异及血压节律的相关性研究(1)
[摘要] 目的 探讨阻塞性睡眠呼吸暂停综合征(OSAHS)与脑梗死后遗症患者心率变异及昼夜血压节律的相关性。方法 选取我院2011年10月～2014年1月收治的脑梗死后遗症患者364 例，其中伴发OSAHS者178例为伴发OSAHS组，余186例为未见OSAHS组，同期筛选体检健康者180例为健康对照组。观测比较三组昼、夜血压及心率变异等指标。 结果 伴发OSAHS组患者心率变异及血压节律指标均超过剩余两组(P<0.01)，未见OSAHS组高于健康对照组(P<0.01)；夜间血氧饱和度比较，伴发OSAHS组比剩余两组低( P<0.01)；未见OSAHS组较健康对照组低(P<0.01)。 结论 OSAHS与脑梗死后遗症患者的心率变异、血压节律存在相关性，影响预后，需高度重视。
[关键词] OSAHS；脑梗死后遗症；睡眠呼吸紊乱指数；血压节律
[中图分类号] R741 [文献标识码] B [文章编号] 1673-9701(2015)11-0035-04
, 百拇医药
[Abstract] Objective To explore the correlation of heart rate variability and blood pressure rhythm day and night for patients with OSAHS and sequelae of cerebral infarction. Methods A total of 364 patients with sequelae of cerebral infarction who were admitted to our hospital from October 2011 to January 2014 were selected. 178 patients complicated with OSAHS were assigned to OSAHS group， and the rest of 186 patients were assigned to non-OSAHS group. 180 people with normal results of physical examination during the same period were selected as healthy control group. Indices such as blood pressure and heart rate variability day and night in the two groups were observed and compared. Results Indices of heart rate variability and blood pressure rhythm were compared， and the indices of patients in OSAHS group were all much higher than those of the rest two groups (P<0.01). Indices of non-OSAHS group were all much higher than those of the healthy control group (P<0.01)； oxyhemoglobin saturation during the night was compared， and OSAHS group was much lower than the rest two groups (P<0.01)； oxyhemoglobin saturation in non-OSAHS group was lower than that in healthy control group (P<0.01). Conclusion OSAHS and sequelae of cerebral infarction are correlated with heart rate variability and blood pressure rhythm， which affect the prognosis and needs to be attached high importance.
, 百拇医药
[Key words] OSAHS； Sequelae of cerebral infarction； Apnea and hypopnea index； Blood pressure rhythm
阻塞性睡眠呼吸暂停综合征(OSAHS)是一种于夜间睡眠时出现的呼吸系统疾病，其病因尚不清楚，主要临床表现为：轻者晚上入睡后打鼾并突然出现呼吸停顿几十秒，日间精神萎靡、昏昏欲睡、体力不佳；重者睡眠时突发呼吸不畅，进而突然起身，满头大汗及濒死体验[1]。因夜间呼吸不畅致缺氧，晨起后患者常觉头晕、头疼，出现易激惹、记忆力与智力稍降低等脾性改变。与夜间呼吸暂停伴随而来的血氧降低及血中CO2显著增高的反复循环，可引发冠心病、高血压、脑血管疾病等，甚者可能猝死[2-4]。故OSAHS是一种可能致死的呼吸系统疾病，更是脑梗死的一种孤立性诱发因素。OSAHS引发心率变异及昼、夜间血压值节律的变化可影响脑梗死的进程，但目前对脑梗死后遗症患者循环系统情况的研究较少。本文主要观察伴发OSAHS脑梗死后遗症患者循环系统受OSAHS的影响情况。
, http://www.100md.com
1 资料与方法
1.1临床资料
所选病例来源于我院2011年10月～2014年1月神经内科收治的确诊为脑梗死后遗症患者364 例。纳入标准：脑梗死诊断符合《中国急性缺血性脑卒中诊治指南2010》[5]；OSAHS 诊断符合《阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南》[6]；获得本院医学伦理委员会的批准，患者及家属均签属知情同意书；实验前均没有使用β受体阻断剂。排除标准：伴有心力衰竭、心脏瓣膜病变、心律严重不齐、继发性高血压或急性冠脉综合征、严重贫血等疾病患者；伴有严重消化系统、神经系统与呼吸系统等系统疾病患者；依从性差或患者及其家属对此存有疑义者。依据患者是否伴发OSAHS分为两组：伴发OSAHS组178例，男99例，女79例，平均年龄(54.2±5.4)岁；未见OSAHS组186例，男103例，女83例，平均年龄(55.1±6.1)岁。同期筛选体检健康者180例为健康对照组(排除OSAHS、脑梗死、心血管疾病、高血压病)，男96例，女84例，平均年龄(54.7±4.8)岁。三组一般临床资料比较，差异无统计学意义(P>0.05)，具有可比性。, 百拇医药(蒋应星 杨辉)
[关键词] OSAHS；脑梗死后遗症；睡眠呼吸紊乱指数；血压节律
[中图分类号] R741 [文献标识码] B [文章编号] 1673-9701(2015)11-0035-04
, 百拇医药
[Abstract] Objective To explore the correlation of heart rate variability and blood pressure rhythm day and night for patients with OSAHS and sequelae of cerebral infarction. Methods A total of 364 patients with sequelae of cerebral infarction who were admitted to our hospital from October 2011 to January 2014 were selected. 178 patients complicated with OSAHS were assigned to OSAHS group， and the rest of 186 patients were assigned to non-OSAHS group. 180 people with normal results of physical examination during the same period were selected as healthy control group. Indices such as blood pressure and heart rate variability day and night in the two groups were observed and compared. Results Indices of heart rate variability and blood pressure rhythm were compared， and the indices of patients in OSAHS group were all much higher than those of the rest two groups (P<0.01). Indices of non-OSAHS group were all much higher than those of the healthy control group (P<0.01)； oxyhemoglobin saturation during the night was compared， and OSAHS group was much lower than the rest two groups (P<0.01)； oxyhemoglobin saturation in non-OSAHS group was lower than that in healthy control group (P<0.01). Conclusion OSAHS and sequelae of cerebral infarction are correlated with heart rate variability and blood pressure rhythm， which affect the prognosis and needs to be attached high importance.
, 百拇医药
[Key words] OSAHS； Sequelae of cerebral infarction； Apnea and hypopnea index； Blood pressure rhythm
阻塞性睡眠呼吸暂停综合征(OSAHS)是一种于夜间睡眠时出现的呼吸系统疾病，其病因尚不清楚，主要临床表现为：轻者晚上入睡后打鼾并突然出现呼吸停顿几十秒，日间精神萎靡、昏昏欲睡、体力不佳；重者睡眠时突发呼吸不畅，进而突然起身，满头大汗及濒死体验[1]。因夜间呼吸不畅致缺氧，晨起后患者常觉头晕、头疼，出现易激惹、记忆力与智力稍降低等脾性改变。与夜间呼吸暂停伴随而来的血氧降低及血中CO2显著增高的反复循环，可引发冠心病、高血压、脑血管疾病等，甚者可能猝死[2-4]。故OSAHS是一种可能致死的呼吸系统疾病，更是脑梗死的一种孤立性诱发因素。OSAHS引发心率变异及昼、夜间血压值节律的变化可影响脑梗死的进程，但目前对脑梗死后遗症患者循环系统情况的研究较少。本文主要观察伴发OSAHS脑梗死后遗症患者循环系统受OSAHS的影响情况。
, http://www.100md.com
1 资料与方法
1.1临床资料
所选病例来源于我院2011年10月～2014年1月神经内科收治的确诊为脑梗死后遗症患者364 例。纳入标准：脑梗死诊断符合《中国急性缺血性脑卒中诊治指南2010》[5]；OSAHS 诊断符合《阻塞性睡眠呼吸暂停低通气综合征诊断和外科治疗指南》[6]；获得本院医学伦理委员会的批准，患者及家属均签属知情同意书；实验前均没有使用β受体阻断剂。排除标准：伴有心力衰竭、心脏瓣膜病变、心律严重不齐、继发性高血压或急性冠脉综合征、严重贫血等疾病患者；伴有严重消化系统、神经系统与呼吸系统等系统疾病患者；依从性差或患者及其家属对此存有疑义者。依据患者是否伴发OSAHS分为两组：伴发OSAHS组178例，男99例，女79例，平均年龄(54.2±5.4)岁；未见OSAHS组186例，男103例，女83例，平均年龄(55.1±6.1)岁。同期筛选体检健康者180例为健康对照组(排除OSAHS、脑梗死、心血管疾病、高血压病)，男96例，女84例，平均年龄(54.7±4.8)岁。三组一般临床资料比较，差异无统计学意义(P>0.05)，具有可比性。, 百拇医药(蒋应星 杨辉)