高原地区老年慢性肺心病夜间睡眠减氧饱和的研究

A PREDICTION OF NOCTURNAL OXYHEMOGLOBIN DESATURATION IN SLEEP STAGE IN ELDERLY PATIENTS WITH CHRONIC COR PULMONALE AT HIGH ALTITUDE

目的：探讨高原老年肺心病夜间睡眠减氧饱和及与呼吸功能的关系。方法：对３４例高原老年肺心病缓解期患者作了白天觉醒时的血气、１秒钟用力呼气容积（ＦＥＶ１）、７５％、５０％和２５％肺活量大呼气流量［Ｖ７５／Ｈｔ（ｍ）、Ｖ５０／Ｈｔ（ｍ）、Ｖ２５／Ｈｔ（ｍ）］、最大跨膈压（Ｐｄｉｍａｘ）和夜间睡眠时的脑电图、眼动图、血氧饱和度（ＳａＯ２）连续监测。结果：高原老年肺心病患者夜间睡眠时快动眼睡眠（ＲＥＭ）和非ＲＥＭ（ＮＲＥＭ）期平均（ＭＳａＯ２）和最低ＳａＯ２（ＭｍＳａＯ２）较白天觉醒ＳａＯ２（ＤＳａＯ２）明显降低，均为Ｐ＜０．０１，以ＲＥＭ期最明显，高碳酸血症组较正常碳酸血症组降低明显（Ｐ＜０．０１或０．０５）。ＭＳａＯ２与ＤＳａＯ２、ＦＥＶ１、Ｖ７５／Ｈｔ（ｍ）、Ｖ５０／Ｈｔ（ｍ）、Ｖ２５／Ｈｔ（ｍ）Ｐｄｉｍａｘ和ＭｍＳａＯ２与ＤＳａＯ２呈明显正相关，ｒ＝０．７３８、０．６８７、０．７７１、０．８８９、０．５６８、０．８７６、０．８２２，均为Ｐ＜０．０１。结论：高原老年肺心病患者夜间睡眠有明显减氧饱和，尤以ＲＥＭ期最明显，且与肺和肺膈肌功能损害程度正相关。

Objetive:To study the prediction of nocturnal oxyhemoglobin desaturation(NOD) in sleep stage in high altitude elderly chronic cor pulmonale(HAECCP) patients.Methods:Daytime blood oxygen saturation (DSaO 2),arterial blood gases,lung function,maximal thansdiaphragmatic pressure(Pdimax)and nocturnal sleep stage electroencphalogram and SaO 2 were measured in 34 patients(mean aged 62 5yrs) with HAECCP in stable stage at 2 260m～3 200m above sea level.Results:Mean SaO 2(MSaO 2) and mean minimal SaO 2(MmSaO 2) during rapid eye movement(REM) and non REM(NREM) sleep were significanly lower than the DSaO 2(all P <0 01),which especially in REM sleep.MSaO 2 and MmSaO 2 in hypercapnia group were significantly lower than those in normocapnia group( P <0 01 or P <0 05),MSaO 2 level positively correlated with DSaO 2,FEV 1 0 ,pdimax and MmSaO 2 level with DSaO 2 ( r =0 738,0 568,0 876 and 0 822,respectively,all P <0 01).Predictive equation of MSaO 2:①y=0 897×DSaO 2+0 025;②y=0 162×FEV 1 0 +0 644;③y=0 044×Pdimax+0 621.Predictive equation of MmSaO 2:y=0 833×DSaO 2+0 028.Conclusion:The results showed that NOD in HAECCP patients is very marked,which especially in REM sleep.Predictive equation of MSaO 2 and MmSaO 2 in sleep was established.