悬雍垂腭咽成形术后阻塞性睡眠呼吸暂停综合征患者心率和血压与自主神经功能恢复的相关性分析

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目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者悬雍垂腭咽成形术(UPPP)术后的恢复情况及心率、血压和自主神经功能的相关性。方法:2018年7月至2019年7月华中科技大学同济医学院附属武汉中心医院收治的通过UPPP治疗的OSAHS患者100例,根据呼吸暂停低通气指数(AHI)将患者分为轻度组(AHI 5 ~15次/h)38例和严重组(AHI>16次/h)62例。治疗前和治疗后通过多导睡眠仪(PSG)及24 h动态心电图监测患者的数据,比较两组患者治疗前后睡眠呼吸的质量,包括AHI、最长呼吸暂停时间(LAT)、最低血氧饱和度(L SaOn 2)和血氧饱和度低于90%的时间占总睡眠时间比例(TSPOn 2 90%);心率,包括最高心率、最低心率和平均心率;心率变异性(HRV)及有关指数,包括全部窦性心搏RR间期(SDNN)、RR间期平均值标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50%)及HRV三角指数;自主神经功能,包括高频段(HF,0.05 ~ 0.15 Hz)、低频段(LF,0.01 ~ 0.05 Hz)及LF/HF;血压,包括收缩压和舒张压。n 结果:与治疗前相比较,轻度组和严重组治疗后AHI、LAT、TSPOn 290%、SDNN、SDANN、RMSSD、PNN50%及HRV三角指数均降低(均n P50 ms in total sinus interval difference (PNN50%) and HRV triangle index; autonomic nerve function of patients, including: high frequency band (HF, 0.05 to 0.15 Hz), low frequency band (LF, 0.01 to 0.05 Hz) and LF/HF; patients′blood pressure, including: systolic and diastolic blood pressure.n Results:Compared with those before treatment, AHI, LAT, TSPOn 2 90%, SDNN, SDANN, RMSSD, PNN50% and HRV trigonometric index were decreased in mild group and severe group after treatment, L SaOn 2 was increased, and there were statistical differences (n P<0.05). Compared with those of mild group, AHI, LAT, TSPOn 2 90%, SDNN, SDANN, RMSSD, PNN50% and HRV trigonometric index were increased in severe group before treatment, LSaOn 2 was decreased, and there were statistical differences (n P<0.05). In the mild group before treatment, mild group after treatment, severe group before treatment and severe group after treatment, the highest heart rates were (127.22 ± 21.87), (72.26 ± 6.15), (143.71 ± 22.09) and (75.03 ± 8.21) beats/min, the lowest heart rates were (50.18 ± 5.21), (61.27 ± 7.10), (42.18 ± 5.13) and (59.67 ± 6.77) beats/min, and the average heart rates were (71.95 ± 8.36), (62.37 ± 6.28), (85.72 ± 11.04) and (64.30 ± 5.89) times/min. After treatment, the maximum heart rate and average heart rate of mild group and severe group were lower than those before treatment, the lowest heart rate was higher than that before treatment, and there were statistical differences (n P<0.05). In the mild group before treatment, mild group after treatment, severe group before treatment and severe group after treatment, the LF were (1107.61 ± 151.69), (768.42 ± 135.18), (1 307.57 ± 182.30), (770.41 ± 160.25) msn 2, HF were (781.81 ± 91.46), (457.24 ± 72.13), (835.03 ± 152.75), (450.44 ± 94.10) msn 2, LF/HF were 1.76 ± 0.25, 1.35 ± 0.14, 1.98 ± 0.32, 1.38 ± 0.11. After treatment, LF, HF and LF/HF in mild group and severe group were lower than those before treatment (n P<0.05); before treatment, LF, HF and LF/HF rate in severe group were higher than those in mild group (n P<0.05). In the mild group before and after treatment, mild group before and after treatment, the systolic blood pressure were (125.01 ± 15.23), (103.22 ± 17.93), (146.13 ± 21.60), (111.25 ± 23.63) mmHg (1 mmHg = 0.133 kPa), and the diastolic blood pressure were (82.27 ± 11.49), (66.13 ± 10.27), (93.52 ± 16.06), (69.10 ± 14.39) mmHg. After treatment, systolic and diastolic blood pressure in mild group and severe group were lower than those before treatment, and there were statistical differences (n P<0.05); systolic and diastolic blood pressure in severe group were higher than that in mild group before treatment, and there were statistical differences (n P<0.05). LF/HF was positively correlated with AHI, mean heart rate, systolic and diastolic blood pressure (n P<0.05), and negatively with HRV triangle index (n P<0.05).n Conclusions:Symptoms of OSAHS patients recover gradually after UPPP, and the recovery of autonomic nerve function is correlated with AHI, heart rate and blood pressure.
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