慢性阻塞性肺疾病患者夜间低氧血症与睡眠分期关系及不同治疗方法干预观察

Relationship between nocturnal hypoxemia and sleep stages in chronic obstructive pulmonary disease,and the outcome of different treatments

目的了解慢性阻塞性肺疾病(COPD)夜间低氧血症患者夜间动脉血氧饱和度(SaO2)变化与睡眠分期之间的关系,以及治疗方法。方法收集27例夜间存在不同程度SaO2下降的COPD患者,分为两组,分别进行无创通气治疗(12例)及持续低流量吸氧(15例),观察治疗前及治疗后生理指标。结果夜间低氧程度在深度睡眠期(3期、4期及REM期)为甚,同时伴有心率加快及血压上升(较1期、2期睡眠,P<0.05);采用BiPAP无创通气治疗可明显改善夜间低氧,持续低流量吸氧亦有改善,但对白天即有低氧血症患者疗效差(与无创通气组比较,P<0.05)。结论对于存在夜间低氧血症的COPD患者,需要针对不同病情采用相应的治疗方法进行干预,以改善夜间缺氧。

Objective To analyze the relationship between sleep-related oxygen desaturation and sleep stages in chronic obstructive pulmonary disease （COPD） patients with nocturnal hypoxemia, and evaluate different treatments of nocturnal hypoxemia. Methods All of the 27 cases were clinically diagnosed as COPD patients with nocturnal hypoxemia. These cases were randomly assigned to two groups, 12 cases were treated by non-invasive positive pressure ventilation （NIPPV） , and the other 17 cases were treated by continuous low flow oxygen inhalation. Results Nocturnal hypoxemia intensified at deep sleep stages （ stage 3, stage 4 and the REM stage）, the heart rate and artery pressure were increasing in deep sleep stages （ to compare with stage 1 and stage 2, P 〈 0. 05 ）. NIPPV could improve the nocturnal SaO2 level in COPD patients with nocturnal hypoxemia, continuous low flow oxygen inhalation could also improve the nocturnal SaO2 level, but got a unsatisfactory treatment outcome in the patients with daytime hypoxemia （ to compare with NIPPV, P 〈 0. 05 ）. Conclusions In order to improve the nocturnal SaO2 level in COPD patients with nocturnal hypoxemia, adequate treatment may be administrated based on pathognostic patient＇s conditions.