整夜多导睡眠监测评估无创正压通气对呼吸危重症监护室患者睡眠的影响研究  

Effects of Non-invasive Positive Pressure Ventilation on Sleep of Patients in Respiratory Intensive Care Unit Assessed by Overnight Polysomnography

作　　者：刘亚男 王玺[1] 张成[1] 申艳娥[1] 马靖[1] 王广发[1] LIU Yanan;WANG Xi;ZHANG Cheng;SHEN Yane;MA Jing;WANG Guangfa(Department of Respiratory and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸和危重症医学科,北京市100034

出　　处：《中国全科医学》2022年第11期1346-1350,共5页Chinese General Practice

基　　金：国家自然科学基金面上项目(52172158)。

摘　　要：背景呼吸危重症监护室(RICU)患者普遍存在睡眠障碍,其中机械通气是导致RICU患者睡眠障碍重要的因素之一。既往研究主要集中在有创正压通气对RICU患者睡眠的影响,但目前尚无应用多导睡眠监测(PSG)分析无创正压通气(NIPPV)对RICU患者睡眠的影响研究。目的通过整夜PSG评估NIPPV对RICU患者睡眠的影响。方法回顾性分析2012年5月至2021年8月于北京大学第一医院RICU 31例行整夜PSG患者的临床资料。收集患者临床资料〔性别、年龄、身高、体质指数、急性生理学与慢性健康状况评分法(APACHEⅡ)评分、基础疾病、主要诊断、白细胞计数、血红蛋白、血白蛋白、超敏C反应蛋白(hs-CRP)、动脉血气分析、呼吸衰竭分型、总住院时间、RICU住院时间、近6个月曾入住RICU情况、住院期间死亡〕、睡眠特征〔呼吸事件:呼吸暂停低通气指数(AHI)、呼吸紊乱指数(RDI)、总监测时间、总睡眠时间、睡眠潜伏期、睡眠效率,睡眠分期:快速动眼睡眠(REM)及非快速动眼睡眠(NREM)时间、潜伏期及占比,脉氧:最低脉氧、睡眠时平均脉氧,心率:最低心率、最高心率、平均心率〕。根据行整夜PSG时是否行NIPPV治疗分为NIPPV组及对照组(非NIPPV组),并比较两组的临床资料和睡眠特征。结果NIPPV组15例,对照组16例。与对照组相比,NIPPV组患者总睡眠时间(P=0.028)、REM时间(P=0.034)、NREM时间(P=0.003)及NREM中N2时间(P=0.003)均缩短,睡眠效率(P=0.038)降低,平均心率增快(P=0.028)。结论睡眠障碍是RICU患者的常见问题,行NIPPV患者更容易出现总睡眠时间缩短、REM睡眠减少及睡眠效率下降。RICU患者应积极行整夜PSG评估睡眠情况并进行适当干预。Background Sleep disorders are commonin RICU patients,with mechanical ventilation as one of the important factors leading to sleep disorders in RICU patients.Previous studies have mainly focused on the effect of invasive positive pressure ventilation(IPPV)on sleep in RICU patients,but there is no study on the effect of polysomnography on sleep in RICU patients with non-invasive positive pressure ventilation(NIPPV).Objective To evaluate patients'sleep disorders and the effect of NIPPV on sleep in patients in respiratory intensive care unitsby overnight polysomnography.Methods The clinical data of 31 patients who underwent overnight polysomnography in the Department of Respiratory and Critical Care Medicine of Peking University First Hospital from May 2012 to August 2021 were retrospectively analyzed.The clinical data〔sex,age,height,body mass index,APACHEⅡ score,underlying diseases,main diagnosis,white blood cell count,hemoglobin,serum albumin,high-sensitivity C-reactive protein(hs-CRP),arterial blood gas analysis,respiratory failure classification,total length of hospital stay,length of stay in RICU,RICU stay in the past 6 months,death during hospitalization〕,sleep characteristics〔respiratory events:apnea-hypopnea index(AHI),respiratory disturbance index(RDI),total detection time,total sleep time,sleep latency,sleep efficiency,sleep stage:time,latency and proportion of REM and NREM,pulse oxygen:minimum pulse oxygen,average pulse oxygen during sleep,heart rate:minimum heart rate,maximum heart rate〕of patients were collected.The patients were divided into NIPPV group and control group(non-NIPPV group)according to whether NIPPV treatment was performed during overnight polysomnography,and the clinical data and sleep characteristics of the two groups were compared.Results There were 15 cases in the NIPPV group and 16 cases in the control group.Compared with the control group,the total sleep time(P=0.028),REM sleep time(P=0.034),NREM time(P=0.003)and N2 sleep time(P=0.003)were shortened in the NIPPV group,whil

关 键 词：睡眠 重症监护病房 睡眠障碍 多导睡眠监测 无创通气 机械通气 

分 类 号：R338.63[医药卫生—人体生理学]