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目的:探讨持续正压通气(CPAP)对阻塞性睡眠呼吸暂停(OSAHS)合并难治性高血压(RH)患者血压的影响。方法:RH合并中重度OSAHS(呼吸暂停低通气指数≥15次/h)患者162例,根据是否自愿接受CPAP分为CPAP组(药物治疗基础上接受12周CPAP,88例,剔除3例不耐受和1例调整药物者)和非CPAP组(仅接受药物治疗,74例,剔除2例调整药物者)。治疗前和治疗12周后行24h动态血压,测清晨卧位血浆肾素-血管紧张素-醛固酮水平。结果:治疗12周后,与非CPAP组比较,CPAP组24h收缩压[(-4.9±5.1)mmHg︰(-0.8±1.2)mmHg]、24h舒张压[(-5.9±5.3)mmHg︰(-1.4±1.7)mmHg]、白昼收缩压[(-4.9±5.2)mmHg︰(-2.1±2.5)mmHg]、白昼舒张压[(-5.1±4.2)mmHg︰(-1.7±1.4)mmHg]以及夜间收缩压[(-4.8±4.9)mmHg︰(0.8±1.3)mmHg]、夜间舒张压[(-6.8±5.6)mmHg︰(-1.0±1.6)mmHg]的血压变化值降低幅度更大(均P<0.05);治疗12周后,CPAP组24h舒张压变异性[(11.4±5.6)︰(14.6±6.4)]、白昼舒张压变异性[(9.5±4.5)︰(11.8±6.2)]以及夜间舒张压变异性[(8.0±4.3)︰(10.9±5.6)]明显降低,且低于非CPAP组(均P<0.05)。结论:中重度OSAHS合并RH患者中,药物治疗基础上12周CPAP能够明显降低24h、白昼及夜间收缩压与舒张压水平,并可使舒张压变异性降低。
Objective: To investigate the effect of continuous positive pressure ventilation (CPAP) on blood pressure in obstructive sleep apnea (OSAHS) patients with refractory hypertension (RH). Methods: 162 patients with RH and moderate-severe OSAHS (apnea-hypopnea index≥15 beats / h) were divided into CPAP group (CPAP group on the basis of CPAP for 12 weeks, 88 cases excluding 3 CPP patients Subjects and 1 patient adjusted medication) and non-CPAP patients (only medication, 74 patients, excluding 2 patients adjusted medication). Before treatment and after 12 weeks of treatment, ambulatory blood pressure was measured 24h, and the level of plasma renin-angiotensin-aldosterone in morning lying position was measured. Results: Compared with non-CPAP group, the systolic blood pressure at 24h after diazepam was (-4.9 ± 5.1) mmHg (-0.8 ± 1.2) mmHg, 24h diastolic pressure was (-5.9 ± 5.3) mmHg︰ (- 1.4 ± 1.7 mmHg], daytime systolic pressure (-4.9 ± 5.2 mmHg︰ -2.1 ± 2.5 mmHg), daytime diastolic pressure (-5.1 ± 4.2 mmHg︰ -1.7 ± 1.4 mmHg), nighttime Systolic blood pressure (-4.8 ± 4.9) mmHg: (0.8 ± 1.3) mmHg] and nighttime diastolic blood pressure (-6.8 ± 5.6) mmHg: (-1.0 ± 1.6) mmHg decreased more significantly (P <0.05). After 12 weeks of treatment, the diastolic blood pressure variability of 24 h (11.4 ± 5.6) :( 14.6 ± 6.4) in CPAP group, variability of daytime diastolic pressure (9.5 ± 4.5) :( 11.8 ± 6.2) The diastolic variability [(8.0 ± 4.3) :( 10.9 ± 5.6)] was significantly lower than that of non-CPAP group (all P <0.05). CONCLUSIONS: In the moderate and severe OSAHS patients with RH, the CPAP at 12 weeks on the basis of drug treatment can significantly reduce the systolic and diastolic blood pressure levels at 24h, daytime and nighttime, and reduce the variability of diastolic pressure.