摘要
目的探讨通过睡眠监测压力滴定技术指导无创通气压力调节对无创通气治疗重叠综合征（OS）呼吸衰竭的疗效，以期为该类患者制定更加有效和安全的无创通气方案。方法研究对象入选标准：（1）经多导睡眠图（PSG）及经肺功能或曾经肺功能检查明确诊断为重叠综合征并血气分析提示存在二型呼吸衰竭的患者；（2）病情允许接受及患者能够耐受整夜PSG监测；（3）神志清醒，觉醒状态下自主呼吸良好；（4）耐受无创通气。剔除标准：（1）频繁呕吐或咯血；（2）自发性气胸；（3）严重的面部外伤或溃疡；（4）气道分泌物过多。自2005年8月至2008年12月共入选27例，其中剔除2例，实际参与研究的患者为25例。采用前瞻性随机双盲平行对照研究，将25例OS呼吸衰竭患者随机分为滴定组13例和对照组12例分别进行无创双水平正压通气（BiPAP）治疗，滴定组患者均予AutoCPAP于睡眠时进行压力滴定，选择最佳呼气压力[EPAP，（8．8±0．5）cmH2O]，作为患者夜间睡眠时的EPAP，晨起后将EPAP再改为5cmH2O；对照组则持续将EPAP定为5cmH2O。观察两组患者的治疗前后睡眠呼吸暂停指数（AHI）、上午10点血气分析、夜间最低血氧饱和度（SPO2 LOW）、治疗后晨起血气分析、夜间呼吸机窒息报警次数、治疗后漏气发生率及其他并发症发生率、有创通气上机率等指标。两组间数据予t检验行统计学分析。结果滴定组与对照组相比SpO2Low改善[（25．9±11．3）％，（14．9±8．4）％]更加明显（t=2．747，P〈0．05）。滴定组治疗后晨起PaO2升高程度（29．4±4．4）mmHg与对照组（22．6±2．1）mmHg相比显著提高（t=4．941，P〈0．0001）；而PaO2下降程度[（16．8±7．3）mmHg，（20．0±6．3）mmHg]相比差异无统计学意义（t=-1．154，P〉0．05）。滴定组上午10点PaO2升高程度（28．9±6．7）mmHg与对照组（
Objective To evaluate the clinical effect of regulating expiratory airway pressure of noninvasive ventilation （NIV） to treat overlap syndrome （OS） with respiratory failure by pressure titration in monitor during sleep. Method Individuals who met the following criteria were selected for the study： （1） OS with respiratory failure confiemed by polysomnogram （PSG） and pulmonary function tests; （2） ability to tolerate PSG tests all night; （3） lucid consciousness and spontaneous breathing upon awaken and （4） ability to tolerate NIV. The criteria of exclusion were ： （ 1 ） frequent expectoration of blood or hemoptysis; （2） spontaneous pneumothorax; （3） severe prosopo-trauma or facial ulcer and （4） large amount of secretion in the airway. From August 2005 to Deeem-her 2008, 27 patients were selected with two patients excluded. The remaining 25 patients treated with noninvasive bi-level positive airway pressure （BiPAP） were randomly assigned to titration group or control group. During sleep, the patients of titration group were put under the optimal expiratory airway pressure [EPAP, （8.8 ± 0.5） cmH2O] which was got from titration by AutoCPAP ventilator and the EPAP decreased immediately to 5 cmH2O when the patients wake up next day. In the patients of control group, the EPAP was maintained at 5 cm H2O round the clock. The degree of apnoea and the hypopnea index （AHI）, the results of arterial blood gas analysis （pH, PaO2, PaCO2） in the morning, the lowest pulse oxygen saturation （SPO2LOW） and the arterial blood gas level at 10 am before and after ventilation, duration of taking off ventilator at night, complications of NIV, incidence of air leakage and invasive ventilation after NIV were comparatively analyzed between the two groups. Results Compared with the control group, the titration group showed a notably increase in the value of SPO2LOW [ （25.9 ± 11.3）% vs. （14.9±8.4）%; P 〈0.05]. The PaO2 level was significantly higher in the titration gr
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2009年第9期952-955,共4页
Chinese Journal of Emergency Medicine
基金
北京市西城区优秀人才培养经费资助项目（2006D015）
关键词
睡眠监测
重叠综合征
无创通气
呼吸衰竭
睡眠呼吸暂停综合征
慢性阻塞性肺疾病
Sleep monitor
Overlap syndrome
Noninvasive ventilation
Respiratory failure
Obstructivesleep apnea syndrome
Chronic obstructive pulmonary diseases
