呼气相负压检测呼气流速受限对阻塞性睡眠呼吸暂停低通气综合征的评价  

Expiratory flow limitation detected by negative expiratory pressure for patients with obstructive sleep apnea/ hypopnea syndrome

作　　者：张挪富[1] 陈爱欢[1] 李俊梅[1] 陈荣昌 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所,510120

出　　处：《国际呼吸杂志》2007年第15期1121-1124,共4页International Journal of Respiration

基　　金：广东省科技厅资助项目（编号：C31106）; 广州市科技局项目（编号：2000038）; 广东省卫生厅资助项目（编号：A2000267）; 广州市科技局重点攻关项目（编号：2005Z2-E0082）

摘　　要：目的　探讨呼气相气道内负压（NEP）检测阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）患者呼气流速受限（EFL）作为评估上气道塌陷性指标的可行性及其与OSAHS严重度的相关性。方法　采用NEP法（-5cmH2O）检测OSAHS患者及健康对照者仰卧位和坐位EFL情况。OSAHS组33例,均为男性,平均年龄（47±12）岁;健康对照组20例,男15例,女5例,平均年龄（42±10）岁。结果　20例健康对照组均无EFL。33例OSAHS患者中10例（30.3%）检测出EFL,其中15例轻中度OSAHS组仅1例（6.7%）出现EFL,而18例重度OSAHS组9例（50%）出现EFL,两组间EFL发生率差异有统计学意义（P〈0.01）。EFL组呼吸暂停低通气指数（AHI）、呼吸暂停总次数（TNA）和低氧指数（DI）均显著高于无EFL组（分别为65.66±22.20和36.50±21.74、372.60±214.46和173.39±133.65、65.18±23.22和38.59±22.02,P均〈0.01）,而夜间最低氧饱和度（NNSp）显著低于无EFL组（58.80±12.78和71.00±9.30,P〈0.01）。3分法和5分法EFL均与AHI、DI、TNA呈显著正相关（3分法EFL的相关系数分别为0.548、0.513、0.472,5分法EFL的相关系数分别为0.560、0.524、0.469,P均〈0.01）,与NNSp呈显著负相关（相关系数分别为-0.514和-0.508,P均〈0.01）。多元回归分析结果显示,5分法EFL对AHI和DI均有显著预测意义（标准化偏回归系数分别为0.495和0.402,P均〈0.01）。结论　采用NEP法在清醒状态下检测EFL可在一定程度上反映OSAHS患者上气道塌陷性增加及OSAHS病情严重程度,可望成为OSAHS初筛诊断和动态观察评估病情严重程度及疗效的简便、可靠的方法。Objective To examine the feasibility of expiratory flow limitation（EFL） measured with negative expiratory pressure （NEP） for evaluation of upper airway collapsibility in the patients with obstructive apnea/hypopnea syndrome（OSAHS） and to determine the relationship between EFL and the severity of OSAHS. Methods Thirty-three patients with OSAHS （all males,47±12 yrs） ,20 healthy adults （male 15, female 5,42± 10 yrs） were included in this study. Full-night polysomonography was performed for all OSAHS patients. EFL was measured by applying negative pressure （--5 cm H20） at the mouth during tidal expiration in seated and supine positions. Results None of 20 healthy adults exhibited EFL. EFL was present in 10（30.3%） out of 33 OSAHS patients,only 1 of 15 patients （6.6%） with mild to moderate OSAHS（AHI 5-40/h） but 9 of 18 patients（50%） with severe OSAHS （AHI〉40/h） showed EFL, the incidence of EFL was different significantly between these two subgroups（ P 〈0.01）. There were significant differences in apnea/hypopnea index（AHI） , total number of apnea（TNA）, desaturation index（DI） and night nadir SPaO2 （NNSp） between the patients with or without EFL（65.66 ± 22.20 vs 36.50 ± 21.74,372.60 ± 214.46 w i73.39± 133.65,65.18± 23.22 vs 38.59±22.02 and 58.80± 12.78 vs 71.00±9.30 respectively,P all〈（0.01）. Both three-point EFL score and five-point EFL score were significantly correlated with AHI, DI and TNA （ P all（0.01）, the Spearman correlation cofficient （r） for three-point EFL score was 0. 548, 0. 513 and 0. 472 respectively and for five-point EFL score was 0. 560,0. 524 and 0. 469 respectively. The EFL s60res（both three and five） were significantly negative correlated with NNSp（all P d0.01）, the correlation coefficient was -0. 514 and -0. 508 respectively. Conclusions EFL detected by NEP during tidal breathing appears to be a useful method for evaluation of upper airway collapsibility in awake OSAHS patients,and EFL may reflect

关 键 词：阻塞性睡眠呼吸暂停/低通气综合征 上气道塌陷性 呼气相气道内负压 呼气流速受限 呼吸暂停低通气指数 

分 类 号：R76[医药卫生—耳鼻咽喉科]