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阜外医院柳志红等研究称:对于严重肺动脉高压患者,应筛查阻塞性睡眠呼吸暂停低通气综合征

2018-02-05 xujing 中国循环杂志

阜外医院柳志红、高柳等研究提示,对于严重肺动脉高压患者,应该注意筛查有无呼吸疾病尤其是阻塞性睡眠呼吸暂停低通气综合征。


阜外医院柳志红、高柳等研究提示,对于严重肺动脉高压患者,应该注意筛查有无呼吸疾病尤其是阻塞性睡眠呼吸暂停低通气综合征。
 
本研究中,缺氧相关肺动脉高压患者的NT-proBNP和6分钟步行距离均低于特发性肺动脉高压患者,缺氧很可能是导致该类肺动脉高压患者预后不良的原因。
 
值得注意的是,缺氧相关肺动脉高压患者中大部分存在阻塞性睡眠呼吸暂停低通气综合征。
 
缺氧相关肺动脉高压患者的睡眠呼吸暂停指数更高,夜间平均血氧饱和度更低。这类患者的平均动脉血氧分压明显低于特发性肺动脉高压患者。
 
钙拮抗剂在缺氧相关肺动脉高压患者中不被推荐,但对于严重缺氧相关肺动脉高压患者,钙拮抗剂的效果还缺乏明确证据。
 
本研究中,3 例患者为急性血管反应阳性,考虑到患者肺动脉高压较重,且未合并支气管痉挛等因素,我们在对症治疗的基础上尝试加用了钙拮抗剂,取得了较好的效果。
 
此外,对阻塞性睡眠呼吸暂停低通气综合征相关肺动脉高压患者,持续正压通气有可能逆转病情。患者若未做睡眠呼吸监测,很可能被误诊为特发性肺动脉高压,从而错失了使用持续正压通气治疗的机会。
 
在本研究中,纳入的患者均为严重肺动脉高压患者,心力衰竭较重,进展较快,但部分患者拒绝接受持续正压通气治疗。对于这类患者我们在密切观察下尝试性加用了靶向药物治疗,患者对治疗反应良好。
 
研究连续入选明确诊断为合并呼吸疾病和(或)缺氧的严重肺动脉高压患者31 例,以及严重特发性肺动脉高压患者41 例

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  5. 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encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Wed Feb 07 13:11:00 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285851, encodeId=85ef285851e4, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76802018286, createdName=元元maple, createdTime=Wed Feb 07 07:21:43 CST 2018, time=2018-02-07, status=1, ipAttribution=)]
    2018-02-27 tomyang96
  6. 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  7. 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    2018-02-07 元元maple

    学到了

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