摘要
目的研究慢性阻塞性肺疾病（ＣＯＰＤ）患者睡眠时低氧血症的发生与否及机制。方法对３０例ＣＯＰＤ患者白天肺功能、动脉血气及夜间血氧水平与正常对照组（８名）进行比较和分析。结果ＣＯＰＤ患者睡眠时血氧水平较正常人明显下降（Ｐ＜０．０５），尤以快动眼睡眠期（ＲＥＭ期）显著，无论夜间平均血氧饱和度（ＭＳａＯ２）还是夜间最低血氧饱和度（ＭｍＳａＯ２），下降程度均明显高于正常人（Ｐ＜０．０５）。从血氧分布情况来看，ＣＯＰＤ患者睡眠时动脉血氧饱和度（ＳａＯ２）＜８０％的时间占睡眠时间百分比（Ｔ８０）、ＳａＯ２＜９０％的时间占睡眠时间百分比（Ｔ９０）亦显著高于正常人（Ｐ＜０．０５）。相关分析表明，白天ＳａＯ２、一秒钟用力呼气容积占用力肺活量比值（ＦＥＶ１％）与ＭＳａＯ２相关（ｒ＝０．７９、０．５４），从而建立了夜间血氧水平的预测公式：ＭＳａＯ２（％）＝１．０３×ＳａＯ２（％）＋０．１９×ＦＥＶ１％（％）－１４．３５（ｒ＝０．８３），白天ＳａＯ２、动脉血二氧化碳分压（ＰａＣＯ２）与睡眠时血氧分布相关：Ｔ８０（％）＝－２．６４×ＳａＯ２（％）＋６．９８×ＰａＣＯ２（ｋＰａ）＋２１１．３１（ｒ＝０．７８），Ｔ９０（％）＝－４．４９×?
Objective To study the pathogenesis of nocturnal hypoxemia in patients with chronic obstructive pulmonary disease (COPD). Method Daytime pulmonary functions, arterial blood gases and nocturnal oxygen level were measured in 30 patients and compared with those of 8 normal subjects. Result The nocturnal oxygen level significantly decreased in patients with COPD compared with that in normal subjects, especially during rapid eye movement (REM) period. The decreased extents of nocturnal mean oxyhemoglobin saturation (MSaO 2) and nocturnal minimum oxyhemoglobin saturation (MmSaO 2) were also very high in COPD ( P <0.05). From the distribution of oxyhemoglobin, the percentage of the time that oxyhemoglobin saturation (SaO 2)<80% and <90% during sleep (T 80 ,T 90 ) in patients were found higher than those in normal subjects ( P <0.05). The sleep time in which SaO 2 below 90 percent obviously increased in COPD patients. The correlative analysis indicated that daytime SaO 2 and FEV 1% were related to the nocturnal mean oxyhemoglobin saturation ( r =0.79, 0.54). So predictive formula of nocturnal oxyhemoglobin level was derived as follows: MSaO 2(%)=1.03×SaO 2(%)+ 0.19 ×FEV 1%(%)-14.35( r =0.83). Daytime SaO 2 and PaCO 2 were also found concerned with nocturnal oxygen distribution: T 80 (%)=-2.64×SaO 2(%)+6.98×PaCO 2(kPa)+211.31( r =0.78), T 90 (%)=-4.49×SaO 2(%)+437.18( r =0.62). Conclusion It was observered that hypoxemia became worse in patients with COPD than in normal subjects during sleep. The level and the distribution of nocturnal oxygen could be predicted by daytime SaO 2 and PaCO 2. All these indicated that nocturnal oxygen therapy could be useful to improve the outcome of the COPD patients.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
1998年第6期348-351,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
卫生部优秀人才基金
关键词
阻塞性肺疾病
低氧血症
预测
Pulmonary disease, obstructive Hypoxemia Sleep
