摘要
目的探讨无创正压通气治疗慢性阻塞性肺疾病(COPD)合并睡眠呼吸暂停综合征(SAS)的临床效果。方法选择2016年1月~2018年12月青岛市第九人民医院收治的诊断为COPD合并SAS的重叠综合征(OS)患者164例,采用随机数表法将患者分为研究组82例和对照组82例,对照组患者给予平喘、解痉、抗感染及吸氧治疗,研究组患者在此基础上给予无创正压通气(NIPPV)治疗,分析治疗前后患者的pH值、二氧分压(PaO2)、血氧化碳分压(PaCO2)等动脉血气指标;以及治疗前和治疗后3个月的肺功能,包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、1秒率(FEV1/FVC%)等,同时监测多导睡眠图技术(PSG)的指标,包括呼吸暂停指数(AHI)、最长呼吸暂停时间、夜间最低氧饱和度(SpO2Low)、总睡眠时间(TST)、觉醒次数(AI)等。结果治疗后,两组患者的pH值和PaO2明显升高,PaCO2明显降低,且研究组PaO2(83.02±19.81)mmHg显著高于对照组(75.71±17.54)mmHg,PaCO2(46.18±8.75)mmHg显著低于对照组(53.16±8.83)mmHg,差异均有统计学意义(P<0.05);两组患者FVC、FEV1、FEV1/FVC水平均明显升高,且研究组FVC、FEV1、FEV1/FVC水平(2.51±0.65)L、(83.52±12.31)ml、(67.12±8.73)均显著高于对照组(2.07±0.57)L、(78.47±14.24)ml、(58.73±7.15),差异均有统计学意义(P<0.05);两组患者的TST和SpO2Low明显升高,AHI、最长呼吸暂停时间、AI明显降低,且研究组的TST为(7.5±1.4)h、SpO2Low(88.2±8.4)%显著高于对照组的(6.8±1.2)h、(84.8±7.3)%,AHI(9.3±2.1)次/h、最长呼吸暂停时间(17.5±4.6)s、AI(13.8±2.5)次/h显著低于对照组的(14.4±3.3)次/h、(20.3±5.0)s、(15.2±2.8)次/h,差异均具有统计学意义(P<0.05)。结论无创正压通气能够提高OS患者的通气质量,积极纠正患者的低氧血症和高碳酸血症等症状,并能够改善患者的肺功能和睡眠质量。
Objective To explore the clinical effect of noninvasive positive pressure ventilation in the treatment of COPD with SAS. Methods 164 patients diagnosed as overlapping syndrome OS in our hospital from January 2016 to December 2018 were selected.The patients were randomly divided into study group (82 cases) and control group(82 cases).The control group was treated routine therapeutic schedule,while the study group was treated with NIPPV.The arterial blood gas analysis indexes such as pH,PaO2 and PaCO2 were compared before and after treatment,and the pulmonary function of patients before and after treatment for 3 months,including FVC,FEV1,FEV1/FVC% and so on. At the same time,PSG indexes were monitored during treatment,including apnea. The index (AHI),the longest apnea time,SpO2 Low,TST,the number of awakenings (AI) and so on.Results After treatment,the pH and PaCO2 of the two groups increased significantly,PaCO2 decreased significantly,and PaCO2 of the study group was significantly higher than that of the control group,PaCO2 was significantly lower than that of the control group(P < 0.05);FVC,FEV1,FEV1/FVC levels of the two groups were significantly increased after treatment,and FVC,FEV1,FEV1/FVC levels of the study group were significantly higher than those of the control group after treatment. The difference between the control group was statistically significant (P < 0.05);after treatment,TST and SPO2 Low in the two groups increased significantly,AHI,longest apnea time and AI decreased significantly,TST,SpO2 Low in the study group were significantly higher than those in the control group,while AHI longest apnea time and AI significantly lower than those in the control group.Conclusion Noninvasive positive pressure ventilation can improve the ventilation quality of OS patients,actively correct the symptoms of hypoxemia and hypercapnia,and improve the pulmonary function and sleep quality of patients.
作者
王新梅
张妍
黄东帅
Wang Xinmei;Zhang Yan;Huang Dongshuai(Department of Respiration,Ninth People's Hospital of Qingdao,Qingdao 266002,China)
出处
《中华保健医学杂志》
2019年第4期326-329,共4页
Chinese Journal of Health Care and Medicine
关键词
慢性阻塞性肺疾病
睡眠呼吸暂停综合征
无创正压通气
睡眠质量
Chronic obstructive pulmonary disease
Sleep apnea syndrome
Noninvasive positive pressure ventilation
Sleep quality
