BiPAP及Auto-CPAP治疗重度OSAHS合并轻中度COPD的临床效果  

The efficacy of BiPAP and Auto-CPAP in patients with severe OSAHS accompanied with mild-to-moderate COPD

作　　者：叶环 邵美琴 施肖红 吴厉锋 徐滨 程恒金 

机构地区：[1]温州市人民医院呼吸内科,浙江温州325000

出　　处：《温州医科大学学报》2017年第5期342-346,共5页Journal of Wenzhou Medical University

基　　金：温州市科技局科研基金资助项目(Y20140532)

摘　　要：目的:探讨双水平气道正压通气(Bi PAP)和自动压力模式持续气道正压通气(Auto-CPAP)呼吸机治疗老年重度阻塞性睡眠呼吸暂停低通气综合征(0SAHS)合并轻中度慢性阻塞性肺疾病(COPD)患者的疗效及安全性。方法:选取老年重度OSAHS合并轻中度稳定期COPD患者40例,利用随机数字表将患者分为BiP AP组和Auto-CPAP组,各20例。分别监测第7、第30、第90、第180天的呼吸暂停低通气指数(AHI)、夜间平均血氧饱和度(M-Sa0_2)、夜间最低血氧饱和度(L-Sa0_2)、血气分析(pH、PaCO_2、PaO_2)、肺功能改变(FEV1/FVC、FEV1%)、呼吸机治疗所需的平均有效治疗压力、平均每晚使用呼吸机时间、Epworth嗜睡量表评分(ESS)、COPD评估测试(CAT)、180 d内COPD急性加重住院率等参数的变化。结果:治疗后第7、第30、第90、第180天,Bi PAP组和Auto-CPAP组AHI、M-Sa0_2、L-Sa0_2、p H、Pa CO2、PaO_2、FEV1/FVC、FEV1%、ESS、CAT等指标差异均无统计学意义(P>0.05)。Auto-CPAP组的平均有效治疗压力小于Bi PAP组,平均每晚使用呼吸机时间大于BiP AP组,差异均有统计学意义(P<0.05)。180 d内COPD急性加重住院率2组间差异无统计学意义(P>0.05)。2组第7、第30、第90、第180天的AHI、PaCO_2、ESS、CAT均较治疗前降低,差异有统计学意义(P<0.05);第7、第30、第90、第180天的PaO_2、M-Sa0_2、L-Sa0_2均较治疗前升高,差异有统计学意义(P<0.05);第7、第30、第90、第180天的FEV1/FVC、FEV1%均较治疗前差异无统计学意义(P>0.05);治疗前后pH无明显变化(P>0.05)。所有病例均未出现明显不良反应(如皮肤压伤、腹胀、气胸等)。结论:BiP AP及Auto-CPAP治疗重度OSAHS合并轻中度COPD疗效相当,安全性均佳,但Auto-CPAP呼吸机组患者依从性更好,所需压力更低,因此,在经济条件欠佳的老年重度0SAHS合并轻中度COPD患者中,采用Auto-CPAP呼吸机治疗可能是一个更好的选择。Objective： To investigate the effcacy and safety of bi-level positive airway pressure （BiPAP） and automatic pressure model of continuous positive airway pressure （Auto-CPAP） ventilation in the treatment of elderly patients with severe obstructive sleep apnea hypopnea syndrome （OSAHS） accompanied with mild-to-moderate chronic obstructive pulmonary disease （COPD）. Methods： According to the random number table, 40 elderly patients with severe OSAHS accompanied with mild-to-moderate COPD were randomly divided into BiPAP group and Auto-CPAP group （n=20, each）. The parameters were monitored at the 7th day, 30th day, 90th day and 180th day, which included apnea hypopnea index （AHI）, the mean pulse oxygen saturation （M-SpO2）, the lowest pulse oxygen saturation （L-SpO2）, blood gas analysis （pH, PaCO2, PaO2）, the changes of pulmonary function （FEV1/FVC, FEV1%）, the mean effective pressure required for ventilation treatment, the ventilator average time nightly, Epworth sleepiness scale （ESS）, COPD assessment test （CAT）, and the hospitalization rate of acute COPD in 180 days were recorded. Results： At the 7th day, 30th day, 90th day and 180th day after treat-ment, AHI, M-SpO2, L-SpO2, pH, PaCO2, PaO2, FEV1/FVC, FEV1%, ESS and CAT all had no signifcant differ-ences between BiPAP and Auto-CPAP group （P〉0.05）. The effective pressure required for ventilation treatmentgroup was more than that in BiPAP group （P〈0.05）. The hospitalization rate of acute COPD in 180 days showed no signifcant difference between these two groups （P〉0.05）. The parameters such as AHI, PaCO2, ESS and CAT at the 7th day, 30th day, 90th day and 180th day were all lower than those before therapy, and the parameters such as PaO2, M-SpO2 and L-SpO2 at the 7th day, 30th day, 90th day and 180th day were all higher than those be-fore therapy in these two groups （P〈0.05）. FEV1/FVC, FEV1% were slightly higher than those before treatment, but there was no signifcant difference （P〉0.05�

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 慢性阻塞性肺疾病 重叠综合征 双水平气道正压通气 自动压力模式持续气道正压通气 治疗结果 

分 类 号：R563.3[医药卫生—呼吸系统]