慢性阻塞性肺疾病患者夜间低通气与呼吸中枢驱动的关系  

Neural respiratory drive and nocturnal hypoventilation in patients with chronic obstructivepulmonary disease

作　　者：徐靖[2] 袁红[1] 伍颖欣[1] 肖思畅[1] 张含嘉[1] 罗远明[1] 

机构地区：[1]广州医学院第一附属医院呼吸内科呼吸疾病国家重点实验室,510120 [2]江苏省淮安市第一人民医院呼吸内科

出　　处：《中华医学杂志》2013年第6期411-414,共4页National Medical Journal of China

基　　金：国家自然科学基金（81270143）

摘　　要：目的探讨慢性阻塞性肺疾病（COPD）患者夜间低通气与呼吸中枢驱动的关系。方法选择在2010年5月至2011年5月就诊于广州医学院第一附属医院呼吸科门诊的稳定期COPD患者13例，对其进行全夜多导睡眠监测的同时记录清醒及睡眠状态下的食管膈肌肌电和每分通气量，食管膈肌肌电和气流分别通过多导食管电极和流量计记录，观察膈肌肌电及肺通气在清醒及不同睡眠期的变化。结果从清醒期到非快速眼动睡眠（NREM）期和快速眼动睡眠期（REM）期，膈肌肌电分别下降26％、39％。每分通气量在清醒期、NREM期和REM期分别为（156±53）、（112±35）和（954±27）ml·min^-1·kg-1，差异均有统计学意义（均P〈0．05）。REM期的平均血氧饱和度为94．0％4±3．9％，显著低于清醒期的97．1％±1．8％（P〈0．01）。结论COPD患者夜问低通气与呼吸中枢驱动下降有关。Objective To explore the effects of neural respiratory drive on ventilation in patients with chronic obstructive pulmonary disease （COPD） during sleep. Methods Diaphragm electromyogram （EMG） from a multipair esophageal electrodes and airflow derived from pneumotachgraphy were recorded during overnight polysomnography in 13 patients with stable COPD recruited from outpatient clinic of First Affiliated Hospital of Guangzhou Medical College from May 2010 to May 2011. Changes in diaphragm EMG and ventilation during wakefulness and different sleep stages were observed. Results Diaphragm EMG decreased by 26% in non-rapid eye movement sleep （ NREM ） stage and 39% in rapid eye movement （REM） as compared with wakefulness. Coinciding with change in diaphragm EMG, ventilation （VE） （ml · min-1· kg-1） significantly decreased from wakefulness （ 156± 53） ml · rain-1 · kg-1 to steady NREM stage （112± 35） ml · rain-1 · kg-1（P 〈 0. 05） and further decreased from NREM stage to REM stage （ 95 ±27 ） ml · rain -1 · kg-1 （ P 〈 0. 05 ）. Oxygen saturation also decreased significantly from 97.1% ~1.8% in wakefulness to REM stage （94.0% ±3.9%） （P 〈 0.01）. Conclusion Reduced neural respiratory drive contributes to nocturnal hypoventilation in COPD patients.

关 键 词：肺疾病 慢性阻塞性 低通气 呼吸中枢 肌电描记术 膈 

分 类 号：R563.9[医药卫生—呼吸系统]