不同水平气道正压通气治疗老年重叠综合征的临床分析

Clinical analysis of BIPAP and CPAP in the treatment of elderly OS

目的探讨双水平气道正压通气(BIPAP)与单水平持续气道正压通气(CPAP)治疗老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并慢性阻塞性肺疾病(COPD),即重叠综合征(OS)患者的治疗效果。方法前瞻性选取2016年6月~2020年1月解放军总医院第六医学中心老年重度OSAHS合并轻中度稳定期COPD患者122例,根据随机数表法分为BIPAP组与CPAP组,各61例。分别监测治疗前、治疗后3周呼吸暂停低通气指数(AHI)、呼吸暂停时间、夜间平均血氧饱和度(M-SaO_(2))、夜间最低血氧饱和度(L-SaO_(2)),肺功能检查(FEV_(1)%、FEV_(1)/FVC%),观察6 min步行实验(6MWT)、血气分析(pH、PaCO_(2)、PaO_(2))等指标的变化。结果两组治疗后AHI、呼吸暂停时间、PaCO_(2)均较治疗前降低,差异有统计学意义(P<0.01);治疗后PaO_(2)、M-SaO_(2)、L-SaO_(2)均较治疗前升高,6 min步行距离增加,差异有统计学意义(P<0.01);治疗后FEV_(1)%、FEV_(1)/FVC%均较治疗前差异无统计学意义(P>0.05);治疗前后pH差异无统计学意义(P>0.05);所有病例均未出现明显不良反应(如皮肤压伤、腹胀、气胸等)。治疗后BIPAP组AHI、呼吸暂停时间、PaCO_(2)较CPAP组降低(P<0.05),PaO_(2)、M-SaO_(2)、L-SaO_(2)升高(P<0.05),6 min步行距离增加,差异有统计学意义(P<0.05)。结论BIPAP与CPAP治疗老年OS疗效确切,安全性好,且BIPAP组效果更为显著,采用BIPAP呼吸机治疗可能是一个更好的选择。

Objective To investigate bi-level positive airway pressure(BIPAP)and single-level continuous positive airway pressure(CPAP)in the treatment of elderly obstructive sleep apnea hypopnea syndrome(OSAHS)with chronic obstructive pulmonary disease(COPD),That was the treatment effect of patients with overlap syndrome(OS).Methods A total of 122 elderly patients with severe OSAHS combined with mild to moderate stable COPD were selected and divided into BIPAP group and CPAP group according to the random number table,with 61 cases in each group.The apnea-hypopnea index(AHI),apnea time,average night blood oxygen saturation(M-SaO_(2)),minimum night blood oxygen saturation(L-SaO_(2)),lung function tests(FEV_(1)%,FEV_(1)/FVC%)were monitored before treatment and 3 weeks after treatment,and the changes of 6-minute walking distance,blood gas analysis(pH,PaCO_(2),PaO_(2))were observed.Results After treatment,AHI,apnea time and PaCO_(2)of the two groups were lower than those before treatment,the differences were statistically significant(P<0.01);PaO_(2),M-SaO_(2),L-SaO_(2)were increased after treatment,and 6min walking distance was increased,the differences were statistically significant(P<0.01);FEV_(1)%,FEV_(1)/FVC%after treatment had no significant difference compared with before treatment(P>0.05);pH had no significant change before and after treatment(P>0.05).There were no obvious adverse reactions(such as skin crush,abdominal distension,pneumothorax,etc.)in all cases.After treatment,AHI,apnea time and PaCO_(2)in BIPAP group were lower than those in CPAP group(P<0.05),while PaO_(2),M-SaO_(2)and L-SaO_(2)were increased(P<0.05),and 6min walking distance was increased(P<0.05).Conclusion BIPAP and CPAP are effective in the treatment of elderly OS with good safety,and the effect of BIPAP group is more significant.BIPAP ventilator may be a better choice.