重叠综合征患者夜间低氧血症相关因素分析与无创通气治疗临床研究

Clinical Research on Night Hypoxemia Related Factors Analysis in Overlap Syndrome and Non-Invasive Ventilation Treatment

目的观察重叠综合征(OS)患者夜间低氧血症相关因素及使用无创通气的疗效。方法对41例OS、44例阻塞型睡眠呼吸暂停低通气综合征(OSAHS)、72例慢性阻塞性肺疾病(COPD)患者分别进行动态血氧Hottle监测和多导睡眠仪(PSG)检查,并对OS患者进行无创通气治疗。结果所有OS患者均有不同程度的夜间低氧血症;白天的动脉血氧饱和度与夜间基础氧饱和度波动水平基本一致,而使用无创通气治疗后则有明显改善,血气分析提示有高碳酸血症的患者发生夜间低氧血症降低的程度更明显;OS患者最低动脉血氧饱和度(SaO2L)显著低于COPD患者(P<0.01);动脉血氧饱和度(SaO2)<90%累计时间的百分率(SLT 90%)显著高于COPD和OSAHS患者(P<0.01);OS患者行无创机械通气后,夜间缺氧和呼吸暂停低通气指数(AHI)明显纠正(P<0.01)。结论 OS患者夜间缺氧较严重,采用无创通气治疗,疗效显著;白天SaO2,PaO2,PaCO2水平变化可能是OS低氧血症的重要决定因素。氧饱和度和血氧分压反映夜间基础氧饱和度水平,而后者能较可靠地预计夜间低氧的严重程度,可能是OS进展、易出现并发症的重要因素。

Objective To investigate the night hypoxemia related factors and the curative efficacy of non-invasive ventilation treatment in overlap syndrome（OS）.Methods Forty-one cases of OS,44 cases of obstructive sleep apnea hypopnea syndrome（OSAHS） and 72 cases chronic obstructive pulmonary disease（COPD） were performed the dynamic blood oxygen Hottle monitor and polysomnography（PSG） examination.The OS cases received non-invasive ventilation treatment.Results All OS cases had different degrees of night hypoxemia.The fluctuation of daytime arterial oxygen saturation（SaO2） was basically consistent with that of night basic oxygen saturation,but after treatment,which was significantly improved.The blood gas analysis revealed that the reduced extent in the patients with hypercapnia was more obvious in occurrence of night hypoxemia.The lowest arterial blood oxygen saturation（SaO2L） in OS patients was significantly lower than that in OSAHS patients（P0.01）.The percentage of the cumulative time of SaO290%in OS patients was obviously higher than that in COPD and OSAH patients（P0.01）.After non-invasive ventilation treatment,night hypoxemia and apnea hyponea index（AHI） in OS patients were obviously corrected.Conclusion The OS patient had severe night hypoxemia.Using non-invasive ventilation has remarkable curative effect.The change of daytime SaO2,PaO2 and the PaCO2 levels change may be the important determining factor of hypoxemia in OS patients.The oxygen saturation and the blood oxygen partial pressure reflect the night basic oxygen saturation level.The latter may be an important factor of OS progress and easy to arise complications.