夜间动态脉氧饱和度监测技术在重度OSAHS患者压力滴定治疗中的作用

Clinical significance of the overnight dynamic pulse oximetry surveillance to the severe OSAHS patients who undergo the pressure titration therapy

目的探讨夜间动态脉氧饱和度监测技术在重度阻塞型睡眠呼吸暂停低通气综合征(OSAHS)患者压力滴定治疗中的临床价值。方法选择2012年6月-2014年6月在我院睡眠监测室已明确诊断的睡眠呼吸暂停低通气指数(AHI)>30次/h的重度OSAHS患者共125例,采用随机单盲法分为A、B两组,两组患者在接受压力滴定治疗前均在本院进行整夜多导睡眠监测(PSG)。A组65例于我院睡眠监测室在PSG下进行整夜人工经鼻持续正压通气(nCPAP)压力滴定,B组60例携带脉搏氧饱和度仪在家中经自动调压呼吸机(auto-CPAP)进行自动压力滴定。结果 B组患者压力滴定治疗后最低脉氧饱和度(LSaO_2)较A组明显提高,差异有统计学意义(P<0.01);B组患者经压力滴定治疗后睡眠呼吸暂停低通气指数(AHI)、氧减指数(ODI)较A组明显降低,差异有统计学意义(P<0.01);而B组自动压力滴定平均90%的治疗压力明显低于A组人工滴定最佳压力,差异有统计学意义(P<0.01)。结论 ODI与AHI具有良好的相关性,ODI、LSaO_2即能良好反映nCPAP的治疗效果;应用脉搏氧饱和度仪在家中指导auto-CPAP进行压力滴定,方法简便宜行,滴定压力值更低,有效提高患者的依从性,使患者更易接受长期家庭无创通气治疗,完全可能替代人工压力滴定。

Objective To demonstrate the clinical significance of the overnight dynamic pulse oximetry during the pressure titration therapy to the severe OSAHS patients by this research. Methods During June 2012 to June 2014, 125 cases of severe OSAHS patients（apnea/hypopnea index, AHI 30/h） confirmed by our sleep monitoring research group had been selected for the research. They are single blinded and randomly divided into A and B two study groups. Everyone in the two study groups are monitored by overnight polysomnography（PSG） before pressure titration therapy. 65 cases in group A are given the overnight artificial nasal continuous positive airway pressure（n CPAP） Titration Therapy, while continuously under PSG surveillance. 60 cases in group B are given the automatic pressure setting respirator（auto-CPAP） pressure titration with overnight dynamic pulse oximetry surveillance at home. Results The lowest oxygen saturation of the Group B（LSa O2） is significantly higher than Group A, and there is a statistical significance between the two groups.（P〈0.01）; The AHI and oxygen desaturation index（ODI） in Group B is significantly lower than that of Group A after pressure titration therapy, and there is a statistical significance between the two groups（P〈0.01）; The 90% of average auto-setting pressure in Group B is lower than the effective artificial nasal CPAP pressure in Group A, and there is a statistical significance between the two groups（P〈0.01）. Conclusion Because of the excellent correlation between the ODI and AHI,the ODI and LSa O2 are able to show the outcome of n CPAP treatment. The overnight dynamic pulse oximetry surveillance guided auto-CPAP pressure titration at home has several advantages over the n CPAP： easy and available to all, lower effective pressure for titration, more compliable from the OSAHS patients. The overnight dynamic pulse oximetry surveillance guided auto-CPAP pressure titration at home is a more acceptable therapy of prolonged, non-traumatic, pressured ventilation and it is a replacement to n CPAP pressure titration therapy.