【作者】 彭友；

【导师】 杨宇；

【作者基本信息】 中南大学 ， 老年医学， 2009， 硕士

【摘要】 目的试评价老年慢性充血性心力衰竭（Congestive Heart Failure,CHF）伴阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep ApneaHypopnea Syndrome,OSAHS）患者的左心功能,分析OSAHS严重程度、夜间低氧和高二氧化碳分压（PaCO2）与左心功能的相关性,探讨OSAHS对心衰患者左心功能的影响。设计横断面调查研究地点湖南省马王堆医院老年病科研究对象2007年2月至2008年12月因冠心病、高血压病或原发性扩张型心肌病引起慢性充血性心衰的住院或门诊老年患者56例。经多导睡眠图（Polysomography,PSG）检测,将心衰患者分为两组:研究组（心衰伴OSAHS）32例和对照组（心衰不伴OSAHS）24例。其中根据呼吸暂停低通气指数（AHI）将研究组分为:轻中度组15例（AHI＜30）和重度组17例（AHI≥30）。研究方法所有研究对象进行多导睡眠监测,超声心动图测量左室射血分数（LVEF）、左室E/A比值并计算Tei指数,采动脉血查血气分析;比较各组间的心肌运动指数（Tei指数）、LVEF、E/A、NYHA分级、多导睡眠图相关指标和血气分析有无差异,分析Tei指数、LVEF、NYHA分级分别与多导睡眠图各指标和血气分析相关指标的相关性,Tei指数和LVEF与纽约心功能分级（NYHA）的相关性。结果1.研究组与对照组组间Tei指数、LVEF、最低血氧饱和度（LSaO₂）、平均血氧饱和度（MSaO₂）、氧减指数（ODI4）、二氧化碳分压（PaCO₂）、动脉血氧饱和度（SaO₂）、NYHA分级均有差异（p＜0.05）,E/A比值组间比较无明显差异。2.方差分析可见,Tei指数、LVEF水平对照组分别与不同程度OSAHS组均有明显差异,不同程度OSAHS组间亦有明显差异,且Tei指数差异尤为显著;E/A值对照组与AHI＜30组有明显差异,但对照组与AHI≥30组及不同程度OSAHS组间无明显差异。3.线性相关分析可见,（1）Tei指数、ODI4、PaCO2与AHI呈正相关（相关系数r分别为0.760、0.928、0.685,p＜0.01）;LVEF、LSaO2、MSaO2、SaO2与AHI呈负相关（r分别为-0.700、-0.830、-0.830、-0.751,p＜0.01）;E/A与AHI无明显相关（r=0.063,p=0.245）。（2）Tei指数与NYHA分级呈正相关（r=0.752,p＜0.01）;LVEF与NYHA分级呈负相关（r=-0.741,p＜0.01）;E/A值与NYHA分级无明显相关性（r=0.240,p=0.075）。4.多元逐步回归分析显示Tei指数的影响因子为AHI（0.725）,回归方程为:Tei指数=0.502+1.125×AHI。LVEF的影响因子为:AHI（-0.483）和LSaO₂（0.319）,回归方程为:LVEF=36.437-0.188×AHI+0.170×LSaO₂。NYHA分级的影响因子为:LSaO₂（-0.621）和SaO₂（-0.315）。回归方程为:NYHA分级=18.745-5.25×LSaO₂-0.133×SaO₂。结论阻塞性睡眠呼吸暂停低通气综合征对老年心衰患者的左心功能损害产生影响;其左心功能损害的严重程度与患OSAHS严重程度相关;Tei指数在评价老年慢性心力衰竭伴OSAHS患者左心整体功能方面有重要临床意义。更多还原

【Abstract】 Objectives To evaluate the left cardiac function of elderly patients with chronic congestive heart failure(CHF) and obstructive sleep apnea hypopnea syndrome(OSAHS),and the relationship between severity of OSAHS,noctumal hypoxia, hypercapnia and left cardiac function. To observe the influence of OSAHS on left cardiac function of the patients with CHF.Design Cross-sectional study.Setting Department of Geriatrics, Mawangdui Hospital, Hunan, Changsha, ChinaParticipants 56 elderly patients with CHF were selected from outpatients and inpatients with coronary heart disease, hypertension or primary dilated cardiomyopathy from Feb.2007 to Dec.2008. These patients were divided into two groups by polysomnography: the research group(32 patients with CHF and OSAHS) and the control group (24 CHF patients without OSAHS). Furthermore, the research group were divided into two groups by apnea-hypopnea index(AHI):15 patients(AHI<30) and 17 patients(AHI≥30).Method After Polysomnography(PSG), we measured all subjects’ left ventricular ejection fraction(LVEF) and left ventricular E/A [peak early transmitral filling velocity(E),late transmitral filling velocity(A), E/A] by doppler echocardiography, calculated myocardial performance index(Tei-index)and assessed arterial blood gas analysis. The associations between the Tei-index, LVEF, newyork heart association(NYHA) heart function classification, polysomnographic and arterial blood gas analysis parameters of each groups were examined by simple regression analysis and stepwise multiple regression analysis. Results 1.The Tei-index, LVEF, lowest oxygen saturation(LSaO2), mean oxygen saturation(MSaO2), oxygen desaturation index four(ODI4), partial pressure of carbondioxide(PaCO2), arterial oxygen saturation (SaO2) and NYHA heart function classification had statistical singnificance in the three groups of the individuals,while the E/A had not. 2.By analysis of variance, the Tei-index and LVEF had significant differences between the control group and the two research groups,and the Tei-index particularly did.The E/A had significant difference between the control group and the research group(AHI<30),but had not between the control group and the research group(AHI≥30) and either in the two research groups.3.(1)The Tei-index,ODI4 and PaCO2 had a positive correlation with AHI;the LVEF, LSaO2, MSaO2 and SaO2 had a negative correlation with AHI; the E/A had not a correlation with AHI. (2)The Tei-index had a positive correlation with NYHA heart function classification and the LVEF had a negative correlation with it, while the E/A had not a correlation with it.4. Stepwise multiple regression analysis selected AHI as independent factor for predicting the Tei-index. Stepwise multiple regression analysis selected AHI and LSaO2 as independent factor for predicting the LVEF. Stepwise multiple regression analysis selected LSaO2 and SaO2 as independent factor for predicting the NYHA heart function classification.Conclusions OSAHS has influence on left cardiac functional damage of elderly patients with CHF, severity of OSAHS is influence factor for predicting the severity of left cardiac functional damage.The Tei-index has important clinical significance for evaluating left cardiac holistic functional of elderly patients with CHF and OSAHS.更多还原