无创通气治疗脊髓性肌萎缩患儿睡眠呼吸紊乱的临床特点分析  

Clinical characteristics of non-invasive ventilation treatment in children with spinal muscular atrophy and sleep disordered breathing

作　　者：郭文卉 曹玲[1] 常丽[1] Guo Wenhui;Cao Ling;Chang Li(Department of Respiratory Diseases, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing100020, China)

机构地区：[1]首都儿科研究所附属儿童医院呼吸内科,北京100020

出　　处：《中华儿科杂志》2019年第10期792-796,共5页Chinese Journal of Pediatrics

基　　金：国家科技支撑计划(2015BAI12B00).

摘　　要：目的探讨无创通气治疗脊髓性肌萎缩(SMA)患儿睡眠呼吸紊乱的有效性和长期作用。方法前瞻性研究2016年3月至2018年1月在首都儿科研究所附属儿童医院呼吸内科就诊,有中重度睡眠呼吸紊乱的17例SMA患儿的夜间无创通气的治疗效果。患儿分为治疗组(使用无创通气)9例和对照组(未使用无创通气),8例拟行无创通气治疗的患儿需完成睡眠呼吸压力滴定。治疗组和对照组患儿均随访1年。采用配对样本t检验,比较完成睡眠呼吸压力滴定的SMA患儿无创通气治疗前后多道睡眠描记术中各参数的变化。采用Mann-WhitneyU秩和检验,比较治疗组和对照组患儿1年内发生呼吸道感染频率的差异。结果17例SMA患儿男10例、女7例,就诊时年龄(5.1±2.9)岁。8例患儿完成睡眠呼吸压力滴定后,多道睡眠描记术结果显示,呼吸暂停低通气指数为(3.8±2.5)次/h,与滴定前(16.6±9.7)次/h相比显著减低(t=4.086,P=0.005),滴定后低通气指数为(2.4±1.2)次/h,与滴定前(7.2±4.7)次/h相比显著减低(t=2.779,P=0.027),滴定后平均血氧饱和度为0.966±0.007,与滴定前0.946±0.015相比有显著改善(t=-5.292,P=0.001),滴定后最低血氧饱和度为0.906±0.023,与滴定前0.786±0.092相比有显著改善(t=-3.938,P=0.006)。治疗组9例长期家庭夜间无创通气患儿呼吸机模式均为双水平气道正压通气S/T模式,吸气相气道正压8~14cmH2O(1cmH2O=0.098kPa),呼气相气道正压4-6cmH2O,1年后患上呼吸道感染1.0(0,3.0)次/年,明显低于8例对照组未使用无创通气患儿的3.0(2.3,7.0)次/年(Z=-2.245,P=0.023),治疗后下呼吸道感染0(0,0)次/年,明显低于对照组的2.0(1.3,4.5)次/年(Z=-3.189,P=0.001),治疗后住院频率0(0,0)次/年,明显低于对照组的1.0(1.0,4.3)次/年(Z=-3.420,P<0.01),治疗后重症监护室住院频率0(0,0)次/年,明显低于对照组的0.5(0,1.0)次/年(Z=-3.353,P=0.029)。结论无创通气可以有效治疗SMA患儿睡眠呼吸紊乱,且长期进Objective To study the short-term and long-term efficacy of the non-invasive ventilation treatment in children with spinal muscular atrophy (SMA) and sleep-disordered breathing. Methods This was a prospective research to study the effect of night-time non-invasive ventilation in children with SMA and moderate to severe sleep-disordered breathing during March 2016 to January 2018, from the Pulmonary Department of Capital Institute of Pediatrics Affiliated Children's Hospital. Patients were divided into the treated group (with night-time non-invasive ventilation) and the control group (without ventilator). Sleep breathing pressure titration was suggested to the patients who were prepared to receive non-invasive ventilation. All cases were followed up for one year. Parameters′changes in polysomnography were assessed (paired t-test) in titration patients. Frequency of respiratory tract infection during the next year in the patients with and without ventilation was collected and compared (Mann-Whitney U-test). Results Seventeen cases were recruited. The average age was (5.1±2.9) years, 10 cases were boys and 7 cases were girls. In the titration group (8 patients), after non-invasive ventilation, the average apnea hypopnea index was (3.8±2.5) times/h (t=4.086, P=0.005), hypopnea index was (2.4±1.2) times/h (t=2.779, P=0.027), average oxygen saturation during total sleep time was 0.966±0.007 (t=-5.292, P=0.001), and the minimum oxygen saturation was 0.906±0.023 (t=-3.938, P=0.006). All the above parameters were significantly improved after treatment. Than before, which was (16.6±9.7) times/h,(7.2±4.7) times/h, 0.946±0.015, 0.786±0.092 respectively. Ventilator mode for the 9 children with long time non-invasive ventilation at home was Bi-level positive airway pressure S/T. The positive airway pressure was set at 8-14 cmH2O (1 cmH2O=0.098 kPa) in inspiratory phase and 4-6 cmH2O in expiratory phase. In the treated group (9 patients), the average frequency of upper respiratory tract infection was 1.0 (0, 3.0) tim

关 键 词：睡眠 呼吸 脊髓性肌萎缩 儿童 多道睡眠描记术 

分 类 号：R746[医药卫生—神经病学与精神病学]