经皮CO2分压监测在睡眠呼吸障碍性疾病中的应用价值  

Value of transcutaneous monitoring of CO2 pressure in the diagnosis and treatment of sleep and breathing disorders

作　　者：刘亚男[1] 董霄松[1] 周薇[2] 李静[1] 安培[1] 赵龙[1] 高占成[1] 韩芳[1] 

机构地区：[1]北京大学人民医院呼吸与危重症医学科,100044 [2]北京老年医院呼吸科

出　　处：《中华医学杂志》2014年第6期408-411,共4页National Medical Journal of China

基　　金：国家科技支撑计划（2012BAI05B00）;北京市科技计划（z21107001012129）

摘　　要：目的 探讨经皮CO2分压（TcPCO2）监测在睡眠呼吸障碍性疾病中的应用价值.方法前瞻性入组2013年1-8月于北京大学人民医院睡眠中心就诊并进行多导睡眠图（PSG）监测的患者29例,其中男23例,女6例;平均年龄（49.5±12.9）岁;体质指数（BMI）（28.2±3.6）kg/m2.行夜间PSG监测的患者同时行整夜TcPCO2监测,TcPCO2信号整合到PSG系统,并与动脉血CO2分压（PaCO2）结果进行对比及Pearson相关分析;对比不同睡眠时相包括非快动眼（NREM）睡眠的N1、N2、N3＋4期、快动眼（REM）睡眠期及无创呼吸机治疗前后TcPCO2的变化.结果 TcPCO2监测结果为（44.2±4.0）mmHg（1 mmHg=0.133 kPa）与对应的 PaCO2（43.2±4.7）mmHg行Pearson直线回归分析发现TcPCO2与PaCO2之间显著相关（r=0.896,P=0.000）.清醒期TcPCO2为（45.8±5.4）mmHg,与各睡眠时相包括N1、N2、N3和REM期均有较好的相关性（r=0.658、0.871、0.898、0.775,P=0.009、0.000、0.003、0.000）,且低于各睡眠时相的数值.REM期TcPCO2有升高趋势,但与N1、N2、N3各期差异均无统计学意义（均P＞0.05）.经无创呼吸机治疗后,患者NREM和REM 睡眠期的TcPCO2显著下降至与清醒时相同水平.结论 TcPCO2监测可以较准确评估PaCO2,且信号稳定,对分析各睡眠分期中CO2的动态变化及指导无创呼吸机的压力滴定具有一定参考价值.Objective To evaluate the clinical value of transcutaneous carbon dioxide （ TcPCO2 ） measurement during sleep respiratory monitoring. Methods A total of 29 patients were prospectively recruited. Their age range was （49. 5 ± 12.9） years and body mass index （BMI） （28.2 ±3.6） kg/m2. All of them underwent polysomnography （PSG） at Sleep Center,Peking University People＇s Hospital during the period of January - August 2013. TcPCO2 signal was entered into PSG systems and TcPCO2 （ TCM4, Radiometer, Demark） measured simultaneously. Arterial blood gas （ABG） analysis for arterial pressure of CO2 （PaCO2 ） was undertaken to validate TcPCO2 measurement. The data were statistically analyzed by Pearson＇s product-moment correlation. Dynamic change of TcPCO2 was monitored during rapid eye movement （REM） and non-rapid eye movement （NREM） sleep stages. The effect of noninvasive positive airway pressure ventilation （NPPV） treatment on TcPCO2 during sleep was also observed. Results TcPCO2 （44. 2 ±4. 0） mmHg （ 1 mmHg = 0. 133 kPa） was highly correlated with PaCO2 （43.2 ± 4. 7） mmHg （ Pearson＇s correlation, r = 0. 896, P = 0. 000 ） , TcPCO2 （ 45.8 ± 5.4 ） mmHg level during wakefulness correlated significantly with that during N1 ,N2, N3 and REM sleep stages （r = 0. 658,0. 871,0. 898,0. 775; P =0. 009,0. 000,0. 003,0. 000）. TcPCO2 levels during different sleep stages were all higher than that of wakefulness. However, TePCO2 levels did not differ between two sleep stages. During both NREM and REM, elevated TcPCO2 returned to the level during wakefulness on NPPV treatment. Conclusions Continuous monitoring of PCO2 is well-tolerated during PSG testing. And the signal is stable. During whole night sleep, TcPCO2 monitoring provides more accurate and clinically acceptable estimation of PaCO2 so that it helps to titrate the NPPV pressure levels.

关 键 词：血气监测 经皮 睡眠障碍 睡眠呼吸暂停综合征 通气机 机械 

分 类 号：R766[医药卫生—耳鼻咽喉科]