论文部分内容阅读
目的探讨交感神经活性、血管内皮功能在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压发病机制中的作用。方法根据整夜多导睡眠监测(PSG)、血压测量和病史采集将93例患者分为:OSAHS 血压正常组、OSAHS 合并高血压组、高血压不合并 OSAHS 组和健康对照组。测定 PSG 当晚睡眠前后血压、血浆去甲肾上腺素、血浆内皮素和血清一氧化氮;收集 PSG 当晚22点至次晨6点的所有尿液送检尿3-甲氨基4-羟苦杏仁酸(VMA)。结果 OSAHS 组患者不论有无高血压,各指标变化为:晨起血浆去甲肾上腺素均显著高于睡前,OSAHS 合并高血压组升高更明显;醒后去甲肾上腺素与醒后平均动脉压、睡眠呼吸暂停低通气指数(AHI)、氧减次数、氧减指数、睡眠期间血氧饱和度低于90%的时间占总睡眠时间的百分比(T90)呈显著正相关,与睡眠时最低血氧饱和度(minSaO_2)和夜间平均血氧饱和度(MSaO_2)呈显著负相关;醒后内皮素显著增高、一氧化氮明显下降,而另外两组则相反;醒后内皮素与醒后平均动脉压、AHI、最长呼吸暂停时间、呼吸暂停总时间、氧减次数、氧减指数、T90呈显著正相关,与 minSaO_2、MSaO_2呈显著负相关;醒后一氧化氮与醒后平均动脉压、AHI、最长呼吸暂停时间、呼吸暂停总时间、氧减次数、氧减指数、T90呈显著负相关,与minSaO_2、MSaO_2呈显著正相关。各组间尿 VMA 无明显变化。结论在 OSAHS 患者夜间一过性血压升高和持续性高血压形成方面,交感神经系统活性增强、血管内皮功能紊乱导致的内皮源性舒、缩因子失衡可能起着重要的作用。
Objective To investigate the role of sympathetic nerve activity and vascular endothelial function in pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS) complicated with hypertension. Methods 93 patients were divided into OSAHS normotensive group, OSAHS combined hypertension group, hypertension without OSAHS group and healthy control group according to overnight polysomnography (PSG), blood pressure measurement and history collection. Determination of PSG night before and after sleep blood pressure, plasma norepinephrine, plasma endothelin and serum nitric oxide; collected PSG 22:00 the next morning to 6 o’clock all the urine urine 3-methylamino 4-hydroxy mandelic acid ( VMA). Results In OSAHS group, no matter whether there was hypertension or not, the change of each index was as follows: plasma norepinephrine was significantly higher than that before bedtime in OSAHS group, OSAHS combined hypertension group was more obvious; after norepinephrine waking up, Pressure, sleep apnea hypopnea index (AHI), oxygen reduction times, oxygen reduction index, sleep oxygen saturation less than 90% of the total sleep time percentage (T90) was significantly positively correlated with the lowest sleep There was a significant negative correlation between blood oxygen saturation (minSaO2) and nocturnal mean oxygen saturation (MSaO2). After waking, the level of endothelin was significantly increased and nitric oxide was significantly decreased, while the other two groups were opposite. After waking endothelin and awake average Arterial pressure, AHI, maximal apnea time, total apnea time, oxygen reduction times, oxygen reduction index, T90 was significantly positive correlation with minSaO_2, MSaO_2 was significantly negatively correlated; waking after nitric oxide and awake mean arterial pressure , AHI, longest apnea time, total apnea time, oxygen reduction times, oxygen reduction index, T90 were significantly negatively correlated with minSaO_2, MSaO_2 was significantly positive correlation. Urinary VMA no significant change between groups. Conclusions OSAHS patients with nocturnal atrophic hypertension and persistent hypertension, the activity of the sympathetic nervous system, vascular endothelial dysfunction caused by endothelial dysfunction, imbalance of factors may play an important role.