AVAPS-AE模式的无创通气对AECOPD合并OSA患者PSG参数、ESS评分及舒适度的影响

Effects of AVAPS-AE Mode of Non-invasive Ventilation on PSG Parameters,ESS Score and Comfort in Patients with AECOPD and OSA

目的探讨平均容积保证压力支持-自动呼气压(AVAPS-AE)模式的无创通气对慢性阻塞性肺疾病急性加重期(AECOPD)合并阻塞性睡眠呼吸暂停(OSA)患者多道睡眠监测(PSG)参数、Epworth嗜睡量表(ESS)评分及舒适度的影响。方法选取2020年1月至2022年10月自贡市第一人民医院75例AECOPD合并OSA患者,随机分为3组,各25例,均行无创通气治疗,对照A组予以AVAPS模式,对照B组予以S/T模式,观察组予以AVAPS-AE模式。比较3组治疗前、治疗24 h、48 h及72 h血气分析指标[动脉氧分压(PaO_(2))、动脉血酸碱度(pH)、动脉二氧化碳分压(PaCO_(2))]、PSG参数[微觉醒指数(MAI)、呼吸暂停低通气指数(AHI)、最低脉搏氧饱和度(miniSpO_(2))、睡眠效率(TST/TRT)]、颏舌肌肌电值(GGEMG)各变量[清醒期及睡眠NREM期张力性、峰值、时相性GGEMG]、人机对抗发生率、48 h插管率、ESS、Brog、视觉模拟量表(VAS)及健康相关生存质量(HRQL)评分。结果治疗24 h、48 h及72 h PaO_(2)组间比较:观察组>对照A组>对照B组(P<0.05);PaCO_(2)组间比较:观察组<对照A组<对照B组(P<0.05);TST/TRT、miniSpO_(2)组间比较:观察组>对照A组>对照B组(P<0.05);AHI、MAI组间比较:观察组<对照A组<对照B组(P<0.05);清醒期及睡眠NREM期张力性、峰值、时相性GGEMG组间比较:观察组<对照A组<对照B组(P<0.05);3组人机对抗发生率、48 h插管率比较,差异无统计学意义(P>0.05);ESS、Brog、VAS评分组间比较:观察组<对照A组<对照B组(P<0.05);HRQL评分组间比较:观察组>对照A组>对照B组(P<0.05)。结论AVAPS-AE模式的无创通气用于AECOPD合并OSA有利于改善患者睡眠,减少日间嗜睡,缓解呼吸困难,提高呼吸舒适度及生存质量。

Objective To investigate the effects of non-invasive ventilation in mean volumetric pressure support and automatic expiratory pressure(AVAPS-AE)mode on multichannel sleep monitoring(PSG)parameters,Epworth sleepiness Scale(ESS)score and comfort in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with obstructive sleep apnea(OSA).Methods 75 patients with AECOPD complicated with OSA in our hospital from January 2020 to October 2022 were randomly divided into 3 groups,each with 25 cases,all of which were treated with non-invasive ventilation.Control group A was treated with AVAPS mode,control group B was treated with S/T mode,and observation group was treated with AVAPS-AE mode.Blood gas analysis indexes[arterial partial pressure of oxygen(PaO_(2)),arterial blood pH(pH),arterial partial pressure of carbon dioxide(PaCO_(2))],PSG parameters[arousal index(MAI),apnea hypopnea index(AHI),minimum pulse oxygen saturation(miniSpO_(2)),sleep efficiency(TST/TRT)]and genioglossus muscle of the three groups were compared The variables of GGEMG(tonic,peak and phasic GGEMG during wakefulness and sleep NREM),the incidence of man-machine confrontation,the rate of intubation at 48 hours,ESS,Brog,visual analogue scale(VAS)and health-related quality of life(HRQL)scores were compared before treatment and after 24,48 and 72 hours of treatment.Results After 24 h,48 h and 72 h treatment,PaO_(2) groups were compared:observation group>control group A>control group B(P<0.05).Comparison between PaCO_(2) groups:observation group<control group A<control group B(P<0.05).Comparison of TST/TRT and miniSpO_(2) groups:observation group>control group A>control group B(P<0.05).Comparison between AHI and MAI groups:observation group<control group A<control group B(P<0.05).Comparison of tension,peak value and phase GGEMG between awake and NREM sleep groups:observation group<control group A<control group B(P<0.05).There was no significant difference in the incidence of man-machine confrontation and 48-h intubation rate among 3 groups(P>0.05).ESS,Brog and VAS were compared between groups:observation group<control group A<control group B(P<0.05);Comparison of HRQL among groups:observation group>control group A>control group B(P<0.05).Conclusion AVAPS-AE mode of non-invasive ventilation for AECOPD combined with OSA is beneficial to improve sleep,reduce daytime sleepiness,relieve dyspnea,and improve breathing comfort and quality of life.