双水平气道正压通气治疗COPD合并OSAHS效果分析

Effect of bi-level positive airway pressure in the treatment of obstructive chronic obstructive pulmonary disease complicated with obstructive sleep apnea hypopnea syndrome

目的分析双水平气道正压通气治疗慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的效果。方法以我院2010年1月至2012年1月间收治的COPD合并OSAHS患者90例为研究对象,随机分为A组和B组。在常规治疗基础上,A组患者使用双水平气道正压通气治疗,B组使用持续气道正压通气进行治疗,比较两组患者血气分析、多导睡眠图、心肺功能、内皮细胞指标及随访情况之间的差异。结果治疗后A组患者血气分析指标(Pa O2、Pa CO2)、多导睡眠图(AHI、最长呼吸暂停时间)、心肺功能(脑钠肽、右心室Tei指数、FEV1/FVC和PEF%)及内皮细胞功能指标(内皮素-1、一氧化氮和凝血酶-Ⅲ)皆优于B组,其差异均有统计学意义(P<0.05)。在24个月的随访中,A组患者生存率显著高于B组(P<0.05)。结论双水平气道正压通气可以有效治疗慢性阻塞性肺疾病合并睡眠呼吸暂停低通气综合征,其可改善患者临床症状,保护患者心肺功能和血管内皮功能,提高患者预后水平。

Objective To investigate the effect of bi-level positive airway pressure in the treatment of chron-ic obstructive pulmonary disease （COPD） complicated with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods Ninety patients with COPD complicated with OSAHS were randomly divided into group A and group B. On the basis of conventional clinical treatment, bi-level positive airway pressure was used in group A, and continuous positive airway pressure was applied in group B. The blood gas analysis, polysomnography （PSG）, cardiopulmonary function, the indexes of endothelial cell function and follow-up results in the 24 mouths were compared between the two groups. Results Group A had significantly better results in blood gas analysis （PaO2, PaCO2）, PSG （apnea hypop-nea index, the longest apnea time）, cardiopulmonary function （brain natriuretic peptide, right ventricular Tei index, FEV1/FVC, PEF%）, and endothelial cell function （endothelin 1, NO, thrombinⅢ）, compared with group B. During the follow-up, the survival rate of group A was significantly higher than that of group B. Conclusion Bi-level positive air-way pressure has significant clinical effects in the treatment of COPD complicated with OSAHS, which can improve the clinical symptoms, protect cardiopulmonary function and endothelial cell function, as well as improve prognosis.