高原地区老年慢性肺心病患者夜间睡眠减氧饱和的观察  

Predictive value of nocturnal oxyhemoglobin desaturation at sleep stage in elderly patients with chronic cor pulmonale at high altitude area

作　　者：杨生岳[1,2] 冯恩志[1,2] 赵宁伟[1,2] 索玉梅[1,2] 詹正嵩[1,2] 董红梅[1,2] 高玲[1,2] 

机构地区：[1]解放军第四医院 [2]军事医学科学院

出　　处：《中华老年医学杂志》1998年第6期342-344,共3页Chinese Journal of Geriatrics

基　　金：解放军总后勤部卫生部’95重点科研课题

摘　　要：目的探讨高原老年肺心病患者夜间睡眠减氧饱和及与呼吸功能的关系。方法对３４例高原老年肺心病缓解期患者作了白天血气、血氧饱和度（ＳａＯ２）、肺功能、最大跨膈压（Ｐｄｉｍａｘ）和夜间睡眠脑电图、眼电图、ＳａＯ２连续监测。结果高原老年肺心病患者夜间睡眠快动眼睡眠（ＲＥＭ）和非ＲＥＭ（ＮＲＥＭ）期平均ＳａＯ２（ＭＳａＯ２）和最低ＳａＯ２（ＭｍＳａＯ２）较白天觉醒ＳａＯ２（ＤＳａＯ２）明显降低（均为Ｐ＜００１），以ＲＥＭ期最明显；高碳酸血症组较无碳酸血症组降低明显（Ｐ＜００１或００５）。ＭＳａＯ２与ＤＳａＯ２、１秒钟用力呼气容积（ＦＥＶ１）、７５％、５０％和２５％肺活量最大呼气流量〔Ｖ７５／Ｈｔ（ｍ）、Ｖ５０／Ｈｔ（ｍ）、Ｖ２５／Ｈｔ（ｍ）（Ｈｔ为身高，ｍ为米）〕、Ｐｄｉｍａｘ和ＭｍＳａＯ２与ＤＳａＯ２呈明显正相关（ｒ＝０７３８、０６８７、０７７１、０８８９、０５６８、０８７６、０８２２，均为Ｐ＜００１）。结论高原老年肺心病患者夜间睡眠有明显减氧饱和，尤以ＲＥＭ期最明显。Objective To study the predictive value of nocturnal oxyhemoglobin desaturation (NOD) at sleep stage in elderly patients with chronic cor pulmonale in high altitude areas(HAECCP). Methods Daytime blood oxygen saturation (DSaO 2), arterial blood gases, lung function, and maximal transdiaphragmatic pressure (Pdimax), and electroencephalogram and SaO 2 at nocturnal sleep stage were measured in 34 patients (mean age: 62 6 years) with HAECCP at stable stage, who lived in areas 2 260 3 200 m above sea level. Results Mean SaO 2 (MSaO 2) and mean minimal SaO 2 (MmSaO 2) during rapid eye movement (REM) and non REM (NREM) sleep, especially in REM sleep, were significantly lower than the DSaO 2 (all P <0 01). MSaO 2 and MmSaO 2 in the hypercapnia group were significantly lower than those in the normocapnia group ( P <0 01 and P <0 05, respectively). MSaO 2 level was positively correlated with DSaO 2, FEV 1 0 and Pdimax, and MmSaO 2 was positively correlated with DSaO 2 ( r =0 783, 0 568, 0 876 and 0 822, respectively, all P <0 01). The predictive equations of MSaO 2 were: (1) y=0 897×DSaO 2+0 025; (2) y=0 162×FEV 1 0 +0 644; (3) y=0 044×Pdimax+0 621. The predictive equation of MmSaO 2 was y=0 833×DSaO 2+0 028. Conclusions NOD, especially in REM sleep, is marked in HAECCP patients. The predictive equations of MSaO 2 and MmSaO 2 in sleep are established.

关 键 词：肺心病 低氧血症 呼吸功能试验 高原地区 老年人 

分 类 号：R541.506[医药卫生—心血管疾病] R594.301[医药卫生—内科学]