摘要
目的总结合并呼吸衰竭、左侧及右侧心功能不全（简称三衰）的睡眠呼吸紊乱（SDB）患者的临床特征。方法回顾性分析1994-2009年北京大学人民医院就诊的三衰合并SDB患者，分析其临床症状、体征及辅助检查特点和对过度通气试验及无创通气治疗的反应。结果入选患者29例，其中男13例，女16例，年龄13—87岁，平均（62±13）岁，平均体重指数为（34±4）ks／m2，其中初诊考虑睡眠呼吸暂停综合征者14例。主要症状为喘憋、颜面或下肢水肿、咳嗽、咳痰、打鼾、嗜睡、尿少及意识不清，共同的体征特点包括肥胖、上气道狭窄、口唇发绀、双肺底湿哕音、心界扩大、颜面或下肢水肿。29例中13例红细胞计数、血红蛋白及红细胞压积升高；26例行肺功能检查，FEV。／FVC占预计值％≥70％者14例，FEV，／FVC占预计值％〈70％者12例，其中6例50％≤FEV1占预计值％〈80％，6例30％≤FEV，占预计值％〈50％。给予正压通气治疗后临床症状明显缓解，血气pH值趋向正常，但部分患者PaCO2及HC03-水平仍较高。胸部影像学及超声检查结果提示肺淤血、胸腔积液、肺动脉高压、全心扩大及左心舒张功能不全，动态血压呈非杓型分布，以夜间血压升高为主，无创通气治疗可使血压明显下降，恢复杓型分布。11例行过度通气试验，脉氧饱和度及血气分析指标均较前改善，患者血气水平恢复正常。结论呼吸衰竭合并左侧及右侧心功能不全的患者中相当一部分与SDB有关。该类患者采用单纯吸氧和药物治疗效果差，无创通气可迅速缓解呼吸衰竭症状并有助于心功能的恢复。自主过度通气试验可作为筛查和鉴别诊断的有效手段。
Objective To assess the clinical characteristics of heart failure and respiratory failure in patients with sleep disordered breathing （SDB）. Methods Symptoms, signs, laboratory tests, clinical courses, blood gases responses to voluntary hyperventilation test and non-invasive ventilation treatment were analyzed in 29 patients with SDB. All patients were diagnosed as right and left heart failure and respiratory failure from 1994 to 2009 in Peking University People＇ s Hospital. Results Among the 29 patients recruited, 13 were male and 16 female. The mean age was 62 ±13 yrs, and BMI was （34 ±4） kg/m2. Fourteen （48.3%） were diagnosed as obstructive sleep apnea syndrome at first visit. Chief complains includes dyspnea, edema, cough, snoring, hypersomnolence, oliguria, and ahered mental status. Common signs include obesity, narrow upper airway, cyanosis, moist rales at the base of lungs, enlarged border of cardiac dullness, edema. Polycythemia was seen in 13 patients （44. 80% ）, among the 26 patients who had underwent pulmonary function tests, 14 had FEV1/FVC 370%, the others were FEV1/FVC 〈 70%, with 6 patients had 50% predict value≤FEV1 〈80% predict value and 6 patients had 30% predict value ≤ FEV, 〈 50% predict value. After positive airway pressure （ BiPAP and CPAP） treatment, symptoms and arterial blood gases test results improved. Chest X-ray, CT scan and UCG show pulmonary vascular congestion and edema with cardiomegaly and possible pleural effusion, pulmonary hypertension, left ventricular diastolic dysfunction. Five patients underwent 24 h blood pressure monitoring showed non-dipping pattern or morning risen pattern of BP. In 11 patients who undertaken the test, voluntary hyperventilation induced significant improvement of SpO2, PaCO2 and PaO2, and most of the parameters returned from typeⅡ respiratory failure to normal level. Conclusion The mobidity of SDB remained to be recognized. This cases report indicated that obese patients complaining of severe dyspnea and edema may ha
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2012年第6期429-434,共6页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金（30770938,81070069）
中德科学中心（CZ538）
关键词
睡眠呼吸暂停综合征
呼吸衰竭
心力衰竭
自主过度通气试验
无创通气
Sleep-disordered breathing
Heart failure
Respiratory failure
Voluntary hyperventilation
Non-invasive ventilation
