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OSAHS对急性心肌梗死患者PCI术后疗效及预后的影响

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摘要:

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后疗效及预后的影响。方法 选择2019年1月至2021年8月于新乡医学院第一附属医院心内科就诊的AMI合并OSAHS的90例患者为研究对象,根据OSAHS病情程度分为三组:病情重度组(n=18)、中度组(n=40)和轻度组(n=32),另选择本院同期就诊的单纯AMI患者40例作为对照组。比较四组患者的睡眠监测结果、PCI术后疗效及不良心血管事件的发生率。结果 随着OSAHS病程程度的加重,低通气指数(AHI)、Epworth嗜睡量表(ESS)评分明显升高,夜间最低血氧饱和度(SaO2)明显降低,四组AHI、夜间最低SaO2、ESS评分比较,差异均有统计学意义(P<0.05);随着OSAHS病程程度的加重,左心室射血分数(LVEF)明显降低,左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)明显升高,四组术前、术后3个月LVEF、LVESD、LVEDD比较,差异均有统计学意义(P<0.05);重度组不良心血管事件发生率明显高于其余三组,差异有统计学意义(P<0.05)。结论 OSAHS病情程度对AMI患者PCI术后疗效及短期预后具有较多不良影响,应早期控制,以便改善预后。

Abstract:

Objective To investigate the influence of obstructive sleep apnea hypopnea syndrome (OSAHS) on curative effect and prognosis in patients with acute myocardial infarction (AMI) after PCI. Methods The patients with AMI complicated by OSAHS (n=90) were chosen from Department of Cardiology in the First Affiliated Hospital of Xinxiang Medical College from Jan. 2019 to Aug. 2021. All patients were divided, according to severity of OSAHS, into severe group (n=18), moderate group (n=40) and mild group (n=32). Meanwhile the patients with only AMI (n=40) were chosen into control group. The sleep monitoring results, curative effect after PCI and incidence rates of major adverse cardiovascular events (MACE) were compared among 4 groups. Results As OSAHS exacerbated, the scores of hypopnea index (AHI) and Epworth sleepiness Scale (ESS) increased significantly and nighttime minimum blood oxygen saturation (SaO2) decreased significantly, and the comparison in scores of AHI, nighttime minimum SaO2 and ESS had statistical significance among 4 groups (P<0.05). As OSAHS exacerbated, left ventricular ejection fraction (LVEF) decreased significantly, left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) increased significantly, and the comparison in LVEF, LVESD and LVEDD had statistical significance among 4 groups before the operation and after operation for 3 months (P<0.05). The incidence rates of MACE were significantly higher in severe group than those in moderate group, mild group and control group (P<0.05). Conclusion The severity of OSAHS has many adverse effects on curative effect and short-term prognosis in AMI patients after PCI, so early control of OSAHS will be good for prognosis.

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