无创机械通气对慢性阻塞性肺疾病合并呼吸衰竭患者睡眠、认知功能的影响  

Effects of noninvasive mechanical ventilation on sleepand cognitive function in patients with chronicobstructive pulmonary disease combined with respiratory failure

作　　者：王建华[1] 胡贵芳[1] 蒋世碧 陈其苹 邓小军[1] 张胜英 Wang Jianhua;Hu Guifang;JiangShibi;Chen Qiping;Deng Xiaojun;Zhang Shengying(Department of Respiratory Medicine,Zigong Third People＇s Hospital,Zigong 643020,China)

机构地区：[1]自贡市第三人民医院呼吸科,643020

出　　处：《国际呼吸杂志》2018年第19期1465-1469,共5页International Journal of Respiration

基　　金：自贡市重点科技项目（2016ZC02）

摘　　要：目的探讨无创机械通气对慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者睡眠、认知功能的影响及相关机制，为提高无创机械通气治疗COPD依从性，指导临床及时干预、治疗提供参考依据。方法选取2016年1月至2017年6月在本院就诊确诊为cOPD急性发作期的患者112例作为研究对象。通过采用匹兹堡睡眠质量指数量表（PSQI）、蒙特利尔认知功能评定量表（MoCA）、简易智能精神状态检查量表（MMSE）分别对确诊COPD合并呼吸衰竭、cOPD对照组患者进行睡眠情况及认知功能评估；比较各组研究对象之间基本资料及呼吸组患者治疗前后睡眠、认知功能情况的差异。结果合并呼吸衰竭的COPD患者PSQI评分高于非呼吸衰竭COPD组，而MoCA及MMSE总分则明显降低，各组间总评分差异有统计学意义。呼吸衰竭患者尤其是合并Ⅱ型呼吸衰竭的COPD患者较非呼吸衰竭COPD组患者空间执行、命名、注意集中、语言计算、抽象思维及回忆能力评分明显降低，差异有统计学意义。经无创机械通气治疗纠正呼吸衰竭的cOPD患者，PSQI、MoCA、MMsE认知评分较治疗前有所改善。认知功能量表中空间执行、命名、注意集中、语言计算、定向及回忆能力评分均较前有所升高，差异有统计学意义。结论呼吸衰竭是导致COPD患者出现广泛认知功能障碍及影响睡眠的重要因素之一。由呼吸衰竭导致的睡眠、认知功能损害有一定的可逆性，积极控制病情、及时有效纠正呼吸衰竭有利于改善认知功能及睡眠情况。Objective To explore the effectand related mechanisms of noninvasive mechanical ventilation on sleep and cognitive function in chronic obstructive pulmonary disease （COPD） patients with respiratory failure. The purpose is to improve the compliance of noninvasive mechanical ventilation for COPD,and provide reference for clinical intervention and treatment in time. Methods One hundred and twelve patients with acute exacerbation of COPD in our hospital from January 2016 to June 2017. The scale of pittsburgh sleep quality index （PSQI）, montreal cognitive assessment （MoCA）and mini-mental state examination （MMSE） were used to evaluate the sleep and cognitive function in COPD complicated with respiratory failure group and COPD control group. The basic data of each group and the difference of sleep and cognitive function before and after treatment were compared. Results The PSQI scores of COPD patients in respiratory failure group were higher than those in non respiratory failure group and normal control group, but the total scores of MoCA and MMSE was obviously lower. The differences of total scores between each group were statistically significant. The spatial execution, nomenclature, concentration of attention, language calculation, abstract thinking and recall scores were significantly lower in patients with COPD combined with respiratory failure, especially combined with type II respiratoryfailure. After the noninvasive mechanical ventilation treatment, the scores of PSQI, MoCA and MMSE were improved more than before. Compared with before treatment, the scores of spatial execution, naming, attention, language calculation, orientationand recall were all higher. The differences were statistically significant. Conclusions Respiratory failure may be one of the most important factors that aggravate the abnormal sleep and cognitive dysfunction in COPD patients. This effect has a certain rever sibility. Positive control of the disease, timely and effective correction of respiratory failure, is conducive to

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 睡眠 认知功能 无创机械通气 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]