阻塞性睡眠呼吸暂停低通气综合征患者日间高碳酸血症的相关因素分析

Daytime hypercapnia in patients with obstructive sleep apnea hypopnea syndrome

目的分析OSAHS患者日间高碳酸血症的发生情况及其相关因素。方法收集2007--2009年就诊于北京大学人民医院，并进行了日间血气分析检查的OSAHS患者共1441例，了解日问高碳酸血症（PaCO，≥45mmHg，1mmHg=0．133kPa）的发生率。对测定了肺功能且不存在明显阻塞性通气功能障碍（FEv，／FVC〉70％）的145例患者根据PaCO2水平分为高碳酸血症组（PaCO2≥45mmHg）和不伴高碳酸血症组（PaCO：〈45mmHg），比较二组的性别、年龄、体重指数、肺功能指标、多导睡眠图（PSG）指标和血气分析值，通过直线回归分析获得PaCO2与其他变量的相关性。结果在未经选择的OSAHS人群中，伴有日间高碳酸血症的发生率为25．2％，除外阻塞性通气功能障碍后，单纯OSAHS患者日间高碳酸血症的发生率为26．9％。伴高碳酸血症组与不伴高碳酸血症组中体重指数、FEV，／FVC％、夜间平均SpO2、夜间最低SpO：存在显著差异。在直线回归分析中，体重指数、Pa02、夜间平均SpO2、SIT90与PaCO2相关（r=1．990、-2．283、-3．023，P〈0．05）。结论约1／4的OSAHS患者存在日间高碳酸血症，CO，潴留可以发生在无明显气流阻塞的患者，与体重指数、PaO2、夜间平均SpO2、SIT与OSAHS患者合并日问高碳酸血症密切相关。

Objectives To evaluate the incidence and factors related to daytime CO2 retention （PaCO2 i〉45 mm Hg, 1 mm Hg = 0. 133 kPa） in Chinese patients with obstruetive sleep apnea hypopnea syndrome. Methods 1441 patients with OSAHS had daytime arterial blood gas analysis were recruited from 2007 to 2009 in Peking University People＇ s Hospital. 145 patients underwent pulmonary function test and had FEV1/FVC ratio over 70% were under further analysis. Sex, age, BMI, pulmonary function, polysomnography （PSG） and blood gas analysis results were recorded. Linear regression analysis wasused to evaluate the relationship between PaCO2 levels and related parameters. Comparison was done between hypercanpnic and eucapnic patients. Results Daytime hypercapnia occuredin 25.2% of the 1441 patients with OSAHS, and 26. 9% in the 145 OSAHS patients who had lung function test and with FEV1/FVC ratio over 70%. PaCO2 was correlated with BMI, PaO2 and the severity of nocturnal hypoxemia as reflected by the mean SpO2 and S1Tgo. This was also confirmed by the comparison between the hypercapnie and eucapnic patients. Conclusions Hypercapnia occurrs in a large part of patients with 0SAHS and normal FEVI/ FVC. BMI, nocturnal hypoxemia and daytime Pa02 level are all contributedto the development of daytime CO2 retention in OSAHS.