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目的探讨无创正压气道通气(CPAP)对老年脑梗死合并阻塞性睡眠呼吸暂停(OSA)患者24h动态血压和心脑血管事件的影响,并分析影响不良心脑血管事件的危险因素。方法选择鞍钢集团总医院2012年5月~2015年5月收治的老年脑梗死合并OSA患者145例,按照随机数字表分为治疗组(CPAP治疗)73例和对照组72例。评估2组患者24h动态血压,随访1年时,用Kaplan-Meier生存曲线评价2组的生存情况,采用ROC曲线分析预测心脑血管事件发生的危险因素。结果出院前2组24h收缩压、24h舒张压、昼间收缩压、昼间舒张压、夜间舒张压均有显著差异(P<0.05)。随访1年时,Kaplan-Meier生存曲线显示,治疗组与对照组中位生存时间无显著差异(365dvs 362d,P>0.05),治疗组心脑血管事件发生率显著低于对照组(21.9%vs 33.3%,P<0.05)。ROC曲线显示,睡眠呼吸暂停指数的曲线下面积为0.70(95%CI:0.61~0.77,P=0.002)和24h收缩压的曲线下面积为0.72(95%CI:0.63~0.81,P=0.003),两者为预测心脑血管事件发生的危险因素。结论 CPAP能有效降低老年脑梗死合并OSA患者24h动态血压,降低心脑血管事件发生率。
Objective To investigate the effects of noninvasive positive airway pressure (CPAP) on ambulatory blood pressure and cardiovascular events in patients with senile cerebral infarction complicated with obstructive sleep apnea (OSA) and to analyze the risk factors affecting adverse cardiovascular and cerebrovascular events. Methods A total of 145 elderly patients with cerebral infarction and OSA admitted to the General Hospital of Anshan Iron and Steel Group General Hospital from May 2012 to May 2015 were randomly divided into treatment group (CPAP treatment) and control group (n = 72). The ambulatory blood pressure was evaluated at 24 hours after operation. Survival of the two groups was evaluated by Kaplan-Meier survival curve at 1-year follow-up. ROC curve analysis was used to predict the risk factors of cardiovascular and cerebrovascular events. Results Before discharge, systolic blood pressure, 24h diastolic pressure, diurnal systolic pressure, diurnal diastolic pressure and nighttime diastolic pressure were significantly different between the two groups before discharge (P <0.05). At 1-year follow-up, Kaplan-Meier survival curves showed no significant difference in median survival between the treated and control groups (365 vs. 362 days, P> 0.05), and the incidence of cardiovascular events was significantly lower in the treated group than in the control group (21.9% vs 33.3%, P <0.05). The ROC curve showed that the area under the curve for sleep apnea index was 0.72 (95% CI: 0.63-0.81, P = 0.003) for the area under the curve 0.70 (95% CI: 0.61-0.77, P = 0.002) and 24h systolic pressure , Both of which are risk factors for predicting cardiovascular events. Conclusion CPAP can effectively reduce ambulatory blood pressure and reduce the incidence of cardiovascular and cerebrovascular events in elderly patients with cerebral infarction and OSA.