高海拔地区慢性肺心病缓解期并阻塞性睡眠呼吸暂停低通气综合症患者的临床特点和NIPPV治疗效果

Characteristics of the stable chronic cor pulmonale patients complicated by obstructive sleep apnea-hyponea syndrome and therapy effect of NIPPV at high altitude area

目的探讨高海拔地区慢性肺心病缓解期并阻塞性睡眠呼吸暂停低通气综合症(OSAHS)患者的临床特点和NIP-PV治疗效果。方法对高海拔地区慢性肺心病(HACCP)缓解期患者40例(A组)和慢性肺心病缓解期并OSAHS患者32例(B组)作了睡眠呼吸暂停低通气指数(AHI)、平均氧饱和度(MSaO2)、平均最低氧饱和度(MmSaO2)、1秒钟用力呼气容积(FEV1)占预计值的百分比(FEV1%)、FEV1/用力肺活量(FVC)比值(FEV1/FVC)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、平均肺动脉压(mPAP)和右心室流出道(RVOT)检测;并对B组进行了夜间持续气道正压无创通气(NIPPV)治疗3周,治疗后重复测定肺功能、动脉血气、mPAP和RVOT。结果B组FEV1%、FEV1/FVC、PaO2、睡眠MSaO2和MmSaO2[分别为(35.2±4.4)%、(42.5±5.4)%、(39.7±4.7)mmHg、(64.0±5.7)%、(51.3±6.1)%]显著低于A组[分别为(44.1±5.6)%、(50.3±6.7)%、(48.2±5.5)mmHg、(73.6±6.2)%、(65.5±6.0)%,均P<0.01],而PaCO2、mPAP、RVOT、AHI[分别为(55.9±7.1)mmHg、(46.2±5.5)mmHg、(40.2±4.2)mm、(46.2±11.2)次/h,]显著高于A组[分别为(46.7±5.4)mmHg、(34.4±4.2)mmHg、(34.1±3.5)mm、(4.5±0.9)次/h,均P<0.01]。B组AHI与FEV1%、FEV1/FVC、PaO2、睡眠MSaO2、MmSaO2均呈显著负相关(分别r=-0.621、-0.633、-0.754、-0.724、-0.719,均P<0.01),与PaCO2、mPAP、RVOT均呈显著正相关(分别r=0.622、0.848、0.784,均P<0.01)。B组夜间NIPPV治疗后,FEV1%、FEV1/FVC、PaO2[分别为(39.0±5.8)%、(46.7±6.8)%、(45.2±5.1)mmHg]显著升高(P<0.01或P<0.05),PaCO2、mPAP、RVOT[分别为(48.3±6.7)mmHg、(38.4±5.7)mmHg、(33.5±3.8)mm]显著降低(均P<0.01)。结论高海拔地区慢性肺心病并OSAHS患者的心肺功能受损较单纯肺心病严重,AHI次数越多心肺功能损害越严重。夜间NIPPV治疗能有效地改善其心肺功能损害。

Objective To assess the characteristics of the stable chronic cor pulmonale（HACCP） patients complicated by obstructive sleep apnea-hyponea syndrome（OSAHS） and therapy effect of NIPPV at high altitude area. Methods There were 40 stable simple HACCP inpatients（ A group） and 32 stable HACCP inpatients complicated by OSAHS（ B group）. The ata in comparisons between the groups were as follows ： apnea-hypopnea index （ AHI ）, sleep mean oxyhemoglobin saturation （ MsaO2 ）, mean minimum SaO2 （ MmSaO2 ）, forced expiratory volume in 1 second（ FEVl ） as expressed percent predicted（ FEV1% ）, FEVl to forced vital capacity（ FEV1/FVC） ,arterial oxygen partial pressure（ PaO2 ） , arterial carbon dioxide partial pressure（ PaCOz ） , mean pulmonary arterial pressure（mPAP） and outflow tract of right ventricle（RVOT）. The B group were treated with nocturnal noninvasive positive pressure ventilation（ NIPPV）, FEV1%, FEV1/FVC,PaO2 , PaCO2 , mPAP, RVOT were measured after 3 weeks treatment. Results FEV1 %, FEV1/FVC, PaO2 , MSaO2 and MmSaO2 in the group B [ （ 35.2 ± 4.4） %, （42.5 ± 5.4 ） %, （ 39.7 ± 4.7 ） mmHg, （ 64.0 ± 5.7 ） %, （ 51.3 ± 6. 1 ） % ] were significantly lower than those in the group A[ （44. 1 ±5.6）%, （50.3 ±6.7）%, （48.2 ±5.5） mmHg, （73.6 ±6.2）%, （65.5 ±6. 0）% all P 〈 0. Ol ]. The measures of PaCO2, mPAP, RVOT, AHI [ （ 55.9 ± 7. 1 ） mmHg, （46.2 ± 5.5 ） mmHg, （40. 2 ± 4.2 ） ram, （ 46. 2 ± 11.2 ） time/ hour] were significantly higher in the group B than those in the group A [ （46.7 ± 5.4）mmHg, （34.4 ± 4.2 ）mmHg, （34. 1± 3.5 ）mm, （4.5 ±0. 9 ） time/hour, all P 〈 0. 01 ） ]. In the group B, AHI was negatively correlated with FEV1%, FEVI/FVC, PaO2 , MsaO2, MmSaO2 （r = -0. 621, - 0. 633, - 0. 754, - 0. 724, - 0. 719, respectively, all P 〈 0.01 ） positive correlated with PaCO2 , mPAP, RVOT（ r = 0. 622,0. 848,0. 784, respectively, all P 〈 0.01 ）. After 3 weeks of treatment, FEV1% , FEVI/FVC, PaO2 [ （ 39.0 ~ 5.8 ） % , （46.7 ± 6. 8 ） %, （ 45.2 ± 5.1 ） mmHg I significantly increased （ P 〈 0. 01 or P 〈 0.05 ） and PaCOz , mPAP RTOV [ （ 48.3 ± 6. 7 ） mmHg, （ 38.4 ± 5.7 ）mmHg, （33.5 ±3.8 ）mini significantly decreased（ all P 〈 0. 01 ）in the group B compared that the before treatment. Conclusion Damage of heart and lung function in HACCP patients complicated by OSAHS is serious. The more AHI ,the more serious of heart and lung function damage. NIPPV can significantly improve damage of heart and lung function in HACCP patients complicated by OSAHS.