高原地区慢性肺心病夜间睡眠时血氧饱和度降低的预测和机制  

Predictive Value of Nocturnal Oxyhemoglobin Desaturation at Sleep Stage in Patients with Chronic Cor Pulmonale at High-Altitude Area

作　　者：杨生岳[1] 冯恩志[1] 沈君礼[1] 索玉梅[1] 赵丽红[1] 吴雪梅[1] 

机构地区：[1]解放军第四医院呼吸内科,西宁810014

出　　处：《中国临床医学》2005年第2期203-205,共3页Chinese Journal of Clinical Medicine

基　　金：全军科研基金项目(01MB014)

摘　　要：目的:研究高原地区慢性肺心病患者夜间睡眠时血氧饱和度降低的发生、预测及机制。方法:对32 例高原肺心病患者白天肺功能、动脉血气及夜间血氧水平与16名正常对照进行比较和分析。结果:高原肺心病患者夜间睡眠时血氧水平较正常人明显下降(p<0.01),尤以快动眼睡眠(REM)期显著。夜间睡眠平均血氧饱和度(MsaO2)、夜间睡眠平均最低血氧饱和度(MmSaO2)下降程度均明显高于正常组(p<0.01)。高原肺心病患者夜间睡眠时动脉血氧饱和度(SaO2 )<85%的时间占睡眠时间百分比(T85)、SaO2<80%的时间占睡眠时间百分比(T80)显著高于正常组(p<0.01)。相关分析表明,白天SaO2、1用力呼气容积占预计值百分比(FEV1%)、最大跨膈压(Pdimax)与夜间睡眠MsaO2 呈显著正相关(r值依次为0.926,0.8400.837,p<0.01)。建立了夜间睡眠SaO2 的预测公式:MsaO2 (%)=1.258×SaO2 (%)+0.044×FEV1%(%)+1.203×Pdimax(cmH2O) 37.975。结论:高原地区慢性肺心病患者夜间睡眠时低氧血症加重,其MsaO2水平可通过白天SaO2、FEV1%Pdimax进行预测,夜间氧疗是治疗高原肺心病患者的必须手段。Objective: To study the Predictive value of nocturnal oxyhemoglobin desaturation at sleep stage in patients with chronic cor pulmonale at high altitude area (HACCP).Methods: Daytime pulmonary functions, arterial blood gases,maximal transdiaphragmatic pressure(pdimax) and nocturnal oxygen level were measured in 32 patients with HACCP and compared with those of 16 normal subjects. Results: The nocturnal oxygen level significantly decreased in patients with HACCP compared with that of normal subjects, especially during rapid eye movement (REM) period. The decreased extents of nocturnal mean oxyhemoglobin saturation (MsaO_ 2) and nocturnal minimum oxyhemoglobin saturation (MmSa0_ 2) were also very high in HACCP (P<0. 01). From the distribution of oxyhemoglobin, the percentage of the time that oxyhemoglobin saturation (Sa0_ 2)< 85% and < 80% during sleep (T_ 85,T_ 80) in patients were found higher than those in normal subjects (p< 0.01). The sleep time in which SaO_ 2 below 85 percent obviously increased in HACCP patients. The correlative analysis indicated that daytime Sa0_ 2,FEV_ 1% and Pdimax were related to the nocturnal MsaO_ 2 (r= 0.926、0.840、0.837,respectively,p<0.01). So predictive formula of nocturnal oxyhemoglobin level was derived as follow: MsaO_ 2(%)=1.258 × SaO_ 2(%)+0.044 × FEV_ 1%(%)+1.203 × Pdimax(cmH_ 2O) - 37.975. Conclusion:It was observered that hypoxemia became worse in patients with HACCP than in normal subjects during sleep. The level of nocturnal oxygen could be predicted by daytime Sa0_ 2,FEV_ 1% and Pdimax. All these indicated that nocturnal oxygen therapy could be useful to improve the outcome of the HACCP patients.

关 键 词：血氧饱和度降低 夜间睡眠 高原地区 慢性肺心病 肺心病患者 1s用力呼气容积 FEV1% 最低血氧饱和度 动脉血氧饱和度 SAO2 血氧水平 睡眠时间 快动眼睡眠 最大跨膈压 百分比 正常对照 动脉血气 相关分析 预测公式 低氧血症 

分 类 号：R472[医药卫生—护理学] R473.6[医药卫生—临床医学]