夜间脉搏-氧饱和度仪在睡眠呼吸暂停低通气综合征压力滴定治疗中的临床应用

目的探讨夜间脉搏-氧饱和度仪在睡眠呼吸暂停低通气综合征（SAHS）治疗中的临床应用价值。方法对44例SAHS患者治疗前后进行夜间动态血氧饱和度（SaO2）监测，对治疗前后夜间各项动态血氧监测指标[氧减饱和指数（ODI4），最低血氧饱和度（LSaO2），平均血氧饱和度（MSaO2），血氧饱和度低于90％的时间占睡眠总时间的百分比（SIT90）]进行比较。35例患者在中午进行家庭自动持续气道正压通气（CPAP）压力滴定，9例在夜间进行家庭自动CPAP压力滴定。结果治疗前、后血氧监测指标（ODI4、LsaO2、MsaO2和SIT90）各组间比较差异有显著性（P均〈0．01）。大多数患者经2～3天调压获得成功。结论SIT90、LSaO2、MSaO2和ODI4等指标可以较好地反映无创正压气道通气的治疗效果，应用脉搏一氧饱和度监测指导呼吸机压力滴定，方法简便而实用，费用低，便于家庭操作。

支气管哮喘临床控制与睡眠呼吸障碍的关系

目的分析合并及未合并睡眠呼吸暂停低通气综合征哮喘患者的临床特点、哮喘临床控制率及相关因素,为哮喘的防治提供治疗策略。方法对88例哮喘患者经睡眠问卷调查及哮喘控制测试(ACT)评分调查,行夜间血氧饱和度监测和肺功能测定,夜间血氧监测指标包括氧减饱和指数(ODI4)、最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)、血氧饱和度低于90%的时间占睡眠总时间的百分比(SIT90%)。按照ACT评分和ODI4值分组,ACT评分≤19分为哮喘临床未控制组,ACT评分>19分为哮喘临床控制组,ODI4值≥10次/h为哮喘合并睡眠呼吸暂停低通气综合征(SAHS)组,ODI4值<10次/h为单纯哮喘组。比较各组肺功能的差异。结果哮喘控制组与哮喘未控制组体质量指数(BMI)、FVC、ODI4、LSaO2、MSaO2、SIT90%差异有统计学意义(P<0.05)。单纯哮喘组与哮喘合并SAHS组哮喘临床控制率(23.8%、6.3%)及汉族与维族哮喘组间哮喘临床控制率(28.6%、9.5%)差异有统计学意义(P<0.05～0.01)。结论哮喘临床控制与否和肺功能、夜间低氧及是否合并SAHS有关,ACT哮喘控制测试评分结合肺功能及夜间血氧监测能够全面评估哮喘患者的病情。

支气管哮喘与睡眠呼吸紊乱的关系

目的探讨支气管哮喘与睡眠呼吸紊乱的关系，提出可行性治疗策略。方法对136例支气管哮喘患者进行睡眠问卷调查及夜间血氧饱和度监测，睡眠问卷包括是否打鼾及白天嗜睡情况（爱波沃斯评分，ESS），夜间动态血氧监测指标包括氧减饱和指数（ODI4）、最低血氧饱和度（LSaO2）、平均血氧饱和度（MSaO2）、血氧饱和度低于90％的时间占睡眠总时间的百分比（SIT90％）。结果45．6％（62／136）的哮喘患者ODI4≥5次／小时，19．1％（26／136）的哮喘患者ODI4≥10次／小时，8．8％（12／136）的哮喘患者ODI4≥15次／lh时，SIT90％≥5％者占49．3％（67／136），SIT90％≥10％者占37．5％（51／136），SIT90％≥15％者占27．9％（38／136）。维族与汉族哮喘患者间体质量指数（BMI），SIT90％及FEV1％比较差异有统计学意义（P〈0．05）。结论汉族与维族哮喘患者中睡眠呼吸紊乱的患病率均较高，且普遍存在夜间低氧现象，维族低于汉族，夜间持续正压通气治疗可能是控制夜间哮喘的重要治疗方法。

急性卒中病人并发急性肺栓塞11例临床分析

目的探讨急性卒中并发急性肺栓塞的临床特点及早期诊断对策。方法对11例急性卒中并发急性肺栓塞病人的临床资料进行回顾性分析。结果本组急性卒中病人并发急性肺栓塞发病率为5.34%,肺栓塞的主要原发病为脑梗死(81.82%),经抗凝治疗均痊愈;临床特点中以急性意识水平下降为首要表现9例(81.82%),11例病人监护中均首先发现脉搏-氧饱和度(SpO2)低于<90%,均经CT肺动脉造影(CTPA)扫描证实并发了急性肺栓塞。结论急性卒中病人发现急性意识水平下降和SpO2低于<90%是提示并发急性肺栓塞的重要指征。

Carbon dioxide accumulation during analgosedated colonoscopy: Comparison of propofol and midazolam

AIM: To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol. METHODS: Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme. All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen. Oxygen saturation (SpO 2 ) was measured by pulse oximetry (POX), and capnography (PcCO 2 ) was continuously measured using a combined dedicated sensor at the ear lobe. Instances of apnea resulting in measures such as stimulation of the patient, a chin lift, a mask maneuver, or withholding of sedation were recorded. PcCO 2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points: baseline, maximal rise, termination of the procedure and 5 min after termination of the procedure. The number of patients in both study groups who regained baseline PcCO 2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS: A total of 97 patients entered this study. The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems. Therefore, 83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n = 42) or midazolam (n = 41) for sedation. Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups, respectively]. A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms. The mean SpO 2 at baseline (%) was 99 ± 1 for the midazolam group and 99 ± 1 for the propofol group. No cases of hypoxemia (SpO 2 < 85%) or apnea were recorded. However, an increase in PcCO 2 that indicated alveolar hypoventilation occurred in both groups after administration of the first drug and was not detected with pulse oximetry alone. The mean interval between the initiation of sedation and the time when the PcCO 2 value increased to more than 2 mmHg was 2.8 ± 1.3 min for midazolam and 2.8 ± 1.1 min for propofol. The mean maximal rise was similar for both drugs: 8.6 ± 3.7 mmHg for midazolam and 7.4 ± 3.2 mmHg for propofol. Five minutes after the end of the procedure, the mean difference from the baseline values was significantly lower for the propofol treatment compared with midazolam (0.9 ± 3.0 mmHg vs 4.3 ± 3.7 mmHg, P = 0.0000169), and significantly more patients in the propofol group had regained their baseline value ± 1.5 mmHg (32 of 41vs 12 of 42,P = 0.0004). CONCLUSION: A significantly higher number of patients sedated with propofol had normalized PcCO 2 values five minutes after sedation when compared with patients sedated with midazolam.

Prediction of pulmonary arterial wedge pressure from arterial pressure or pulse oximetry plethysmographic waveform

Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP) Methods Fourteen American Society of Anesthesiologists grade Ⅰ-Ⅱ patients aged 33-69 years and weighing 62 0±9 5 kg scheduled for elective abdominal tumor surgery were studied Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35% Pre operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet , dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation Central venous pressure was maintained at 10-12 mm Hg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre during apnea were used to calculate arterial pressure ratio (APR) Results APR, SPV, dDown, SPV plet and dDown plet all correlated well with PAWP ( r =0 717, -0 695, -0 680, -0 522 and -0 624 respectively, P <0 01) There was a closer linear correlation between APR and PAWP than between the other parameters The regression equation was PAWP (mm Hg)=0 207×APR (%)-0 382 Conclusion During positive pressure mechanical ventilation, APR, SPV, dDown, SPV plet and dDown plet can be used to estimate PAWP effectively