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目的评价经鼻无创正压通气(nCPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)血栓前状态(PTS)的治疗效果。方法收集北京世纪坛医院2003年9月至2005年9月确诊的OSAS患者30例及同期健康对照者30名,血样采取均在经过前一夜睡眠监测及睡眠监测并nCPAP治疗后(OSAS组)仰卧位时立即进行。结果OSAS组与健康对照组比较,OSAS患者血液中血小板α颗粒膜蛋白-140(GMP-140)升高;部分凝血活酶时间(APTT)、抗凝血酶Ⅲ复合物(AT-Ⅲ)以及血浆组织型纤溶酶原激活物(t-PA)降低,血浆组织型纤溶酶原抑制物(PAI)升高,与健康对照组比较各个指标在两组之间的差异均有统计学意义。nCPAP治疗后OSAS组呼吸紊乱指数由(63.21±23.23)/h降至(0.56±0.84)/h,夜间最低血氧饱和度由0.68±0.07上升至0.90±0.02,GMP-140和PAI分别降至(17.07±7.97)%、(95.83±5.91)%,AT-Ⅲ和t-PA分别升高至(95.20±6.67)%、(5.45±1.61)μg/L。结论OSAS患者存在PTS,nCPAP治疗可部分或全部逆转PTS,减少与OSAS相关的心脑血管栓塞性疾病的发生。
Objective To evaluate the therapeutic effect of nasal noninvasive positive pressure ventilation (nCPAP) on the prethrombotic state of obstructive sleep apnea syndrome (OSAS). Methods 30 patients with OSAS and 30 healthy controls were collected from Beijing Shijitan Hospital from September 2003 to September 2005. The blood samples were collected after the previous night’s sleep monitoring and sleep monitoring and nCPAP treatment (OSAS group) Bit immediately. Results In the OSAS group, the platelet α-granule membrane protein-140 (GMP-140) in the blood of patients with OSAS was higher than that of the healthy controls. The partial thromboplastin time (APTT), antithrombin Ⅲ complex The levels of plasma t-PA and PAI were significantly higher in both groups than those in healthy controls . The index of respiratory disturbance in OSAS group decreased from (63.21 ± 23.23) / h to (0.56 ± 0.84) / h after nCPAP treatment, and nighttime oxygen saturation increased from 0.68 ± 0.07 to 0.90 ± 0.02, while GMP-140 and PAI decreased to (17.07 ± 7.97)% and (95.83 ± 5.91)%, respectively. The levels of AT-Ⅲ and t-PA increased to (95.20 ± 6.67)% and (5.45 ± 1.61) μg / L, respectively. Conclusions There is PTS in patients with OSAS. NCPAP can partially or totally reverse PTS and reduce the occurrence of cardiovascular and cerebrovascular embolism associated with OSAS.