睡眠监测压力滴定在阻塞性睡眠呼吸暂停低通气综合征的应用

Use of Sleep Respiration Monitoring Auto-Pressure Titration in Obstructive Sleep Apnea-Hypopnea Syndrome

目的 :应用睡眠监测压力滴定来了解阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)围手术期的情况。方法 :治疗组为资料完整的 4 8例进行睡眠压力滴定的OSAHS患者 ,在患者入院的第 1d用纤维喉镜与M櫣ｌｌｅｒ检查法相结合测量上气道平面的阻塞程度 ,并进行多导睡眠呼吸监测 7h ,观察患者的血氧饱和度、睡眠呼吸暂停低通气指数及血压、心率等情况 ,在第 2d再将多导睡眠监测仪与呼吸机联机监测 7h ,除观察上述指标变化外 ,还观察CPAP呼吸机的工作压力和面罩压力情况。对照组为未进行睡眠压力滴定的 76例OSAHS患者。结果 :M櫣ｌｌｅｒ试验中治疗组有 4 0例为Ⅱ型 ,8例为Ⅳ型 ,对照组中 6 1例为Ⅱ型 ,1例为Ⅲ型 ,1 0例为Ⅳ型。治疗组第 1d和第 2d 90 %以下氧减饱和度指数和AHI均有高度显著性差异 (P <0 .0 1 ) ,这两天的血压也有显著性差异 (P <0 .0 5 ) ,但心率之间无显著性差异 (P >0 .0 5 ) ;持续正压通气 (CAPA)压力分布范围及面罩压力分布范围分别为 (1 1 .0 0± 5 .1 8) ,(9.4 1± 4 .2 8)cmH2 O ;治疗组有 1例行气管切开 ,对照组有 2 6例行气管切开。结论 :让患者术前配戴 1周CPAP ,进行围手术期处理 ,可以改善患者的缺氧状态 ,提高患者对麻醉及手术的耐受力 ,从而降低术中。

Objective: To study the effect of sleep respiration monitoring auto pressure titration on the preoperation of obstructive sleep apnea hypopnea syndrome(OSAHS). Methods: Therapy group including 48 OSAHS patients was tested with fiber laryngoscope and Müller test to measure the degree of obstruction, and polysomnography(PSG) for 7 hours, and was observed the various of SaO 2, apnea hyndrome index(AHI),blood pressure and heart rate at the first in hospital day. At the next day, the above various and the pressure of continuous positive airway pressure(CPAP) respirator working and face guard were observed when the PSG meter and respirator was also used. 76 OSAHS patients without sleep respiration monitoring auto pressure titration were involved in control group. Results: ①There were 40 patients diagnosed as type Ⅱ, and 8 as type Ⅳ in the therapy group. There were 61 patients diagnosed as type Ⅱ,1 as type Ⅲ and 10 as type Ⅳ in the control group. ② Twenty six patients were operated with simplex tracheotomy in control group while only one case was operated in therapy group. ③In the therapy group there was obvious difference between the first day and the second day in SaO 2 and AHI (P<0.01). Conclusion: It could improve the tolerance in operation to be pre treated with CPAP respirator for a week before operation.