家庭式夜间经鼻双水平气道正压通气治疗对重叠综合征患者肺功能及睡眠结构的影响  

Changes of lung function and sleep architecture of overlap syndrome patients undergoing home transnasal bi -level positive airway pressure ventilation at night

作　　者：肖永龙[1] 张德平[1] 母国华[1] 杭美琴[1] 郑培德[1] 侯杰[1] 

机构地区：[1]南京大学医学院附属鼓楼医院呼吸内科,210008

出　　处：《中国医师进修杂志（内科版）》2007年第3期31-34,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨连续长期家庭式夜间经鼻双水平气道正压（BiPAP）通气治疗对重叠综合征（OS）患者肺功能及睡眠结构的影响。方法选择能接受连续长期家庭式夜间经鼻BiPAP通气治疗的OS患者，采用第1次压力滴定时压力值连续治疗6个月，比较治疗前后肺功能及睡眠结构的变化。结果共11例患者完成6个月家庭式夜间经鼻BiPAP通气治疗，第1次压力滴定时：吸气气道正压（1．28±0．19）kPa，呼气气道正压（0．86±0．15）kPa，用第1次压力滴定值连续治疗6个月。6个月后第2次压力滴定时：吸气气道正压（1．31±0．22）kPa，呼气气道正压（0．90±0．15）kPa。第1次压力滴定时第1秒钟用力呼气容积／用力肺活量（FEV1／FVC）为（64．83±5．12）％，第2次滴定时为（66.58±4.60）％，P〈0．05。第1次压力滴定前呼吸紊乱指数（RDI）48.4次／h（24．7—70．2次／h），睡眠分期：S1期（26．97±8．42）％，S2期（60．96±10．69）％，S3＋S4期（8．34±3．22）％，快速眼动（REM）期（3．10±2．46）％。第1次压力滴定时RD10．3次／h（0～5．2次／h），睡眠分期：S1期（9．06±5．17）％，S2期（52．05±6．91）％，S3＋S4期（17．36±3．73）％，REM期（21．19±6．18）％。第2次压力滴定时RD10．2次／h（0～2．7次／h），睡眠分期：S1期（8．09±3．74）％，S2期（53．35±4．25）％，S3＋S4期（18．07±4．37）％，REM期（18．61±5．39）％。结论夜间经鼻BiPAP通气治疗可有效改善OS患者睡眠结构、氧合状况和肺功能。Objective To explore the change of the lung function and sleep architecture of overlap syndrome patients undergoing home transnasal bi -level positive airway pressure（BiPAP） ventilation at night. Methods Patients with overlap syndrome who agreed to accept BiPAP therapy at night were enrolled and ventilated with the pressure that were titrated at first therapy night at sleep laboratory and then underwent night nasal BiPAP ventilation for 6 months at home. Six months later, the pressure was retitrated and the effect of BiPAP ventilation was compared to that at the first therapy night. Results Totally 11 patients with overlap syndrome finished 6 months home night nasal BiPAP ventilation therapy, with the inspiratory positive airway pressure （IPAP） （1.28 ± 0. 19） kPa and expiratory positive airway pressure （EPAP） （0.86 ±0.15） kPa. At the end of 6 months home BiPAP ventilation therapy, the pressure was retitrated with the results of IPAP （ 1.31 ± 0.22 ） kPa and EPAP （0.90 ± 0.15 ） kPa. Lung function improved after 6 months BiPAP ventilation therapy compared with patients＇ basic lung function （FEV/FVC） ,before （64.83 ± 5. 12）% and after （66.58 ± 4. 60）%, P 〈 0.05. Polysomnography （PSG） was conducted before therapy, at the initial pressure titration night and the pressure retitration night 6 months later respectively. The results of PSG indices before therapy were as follows： respiratory disturbance index （RDI） median （ interquartile range ） 48.4 times/h（24.7 -70.2 times/h） , stage 1 sleep （S1 stage） （26.97±8.42）%, stage 2 sleep （S2 stage） （60.96 ± 10.69）%, stage 3 ＋4 sleep （ S3 ＋ S4 stage） （8.34 ± 3.22） %, rapid eye movement （REM） stage （ 3.10 ± 2.46） %. At the initial pressure titration PSG indices were： RDI median（ interquartile range ） 0.3 times/h（0- 5.2 times/h）, S1 stage（9.06 ± 5.17）% , S2 stage（52.05 ± 6.91 ）% , S3 ＋S4 stage（ 17.36 ±3.73）%, REM stage （21.19 ± 6.18）%, and 6 mo

关 键 词：机械通气 睡眠呼吸暂停低通气综合征 慢性阻塞性肺疾病 

分 类 号：R563.5[医药卫生—呼吸系统]