持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者气道阻力及肺动态顺应性的影响研究
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摘要
背景持续气道正压通气是临床治疗阻塞性睡眠呼吸暂停综合征(OSAS)的常用手段之一,但呼吸机治疗周期较长可能导致患者呼吸肌功能性衰退,因此持续气道正压通气对OSAS患者肺功能的影响尚存在一定争议。目的探讨持续气道正压通气对OSAS患者气道阻力及肺动态顺应性的影响。方法选取2015年3月—2018年2月武警陕西省总队医院收治的OSAS患者123例,根据治疗方法分为对照组(n=60)和试验组(n=63)。在常规治疗基础上,对照组患者给予福多司坦片治疗,试验组患者给予持续气道正压通气治疗;两组患者均连续治疗2周。比较两组患者治疗前后睡眠呼吸情况〔包括呼吸暂停低通气指数(AHI)、最高血氧饱和度(SpO2)、最低SpO2、低通气次数、呼吸暂停次数、呼吸暂停时间〕、血压〔收缩压(SBP)、舒张压(DBP)〕、心率(HR)、呼气时气道阻力、吸气时气道阻力、肺动态顺应性,并观察两组患者治疗期间不良反应/并发症发生情况。结果 (1)治疗前两组患者AHI、最高SpO2、最低SpO2、低通气次数、呼吸暂停次数、呼吸暂停时间比较,差异无统计学意义(P>0.05);治疗后试验组患者AHI、低通气次数、呼吸暂停次数低于对照组,最高SpO2、最低SpO2高于对照组,呼吸暂停时间短于对照组(P<0.05)。(2)治疗前两组患者SBP、DBP、HR比较,差异无统计学意义(P>0.05);治疗后试验组患者SBP、DBP、HR低于对照组(P<0.05)。(3)治疗前两组患者呼气时气道阻力、吸气时气道阻力及肺动态顺应性比较,差异无统计学意义(P>0.05);治疗后试验组患者呼气时气道阻力、吸气时气道阻力低于对照组,肺动态顺应性高于对照组(P<0.05)。(4)两组患者治疗期间不良反应/并发症发生率比较,差异无统计学意义(P>0.05)。结论持续气道正压通气可有效改善OSAS患者睡眠呼吸情况,降低血压、HR及气道阻力,提高肺动态顺应性,且安全性较高。
Background Continuous positive airway pressure ventilation is one of commonly used methods in treating obstructive sleep apnea syndrome(OSAS)on clinic,but long-term treatment of breathing machine may lead to functional decline of respiratory muscles,thus there is some controversy about the impact of continuous positive airway pressure ventilation on pulmonary function in patients with OSAS. Objective To investigate the impact of continuous positive airway pressure ventilation on airway resistance and pulmonary dynamic compliance in patients with OSAS. Methods A total of 123 patients with OSAS were selected in Shaanxi Provincial Armed Police Corps Hospital from March 2015 to February 2018,and they were divided into control group(n=60)and test group(n=63)according to therapeutic method. Based on conventional treatment,patients in control group received fudosteine tablets,while patients in test group received continuous positive airway pressure ventilation;both groups continuously treated for 2 weeks. Pre-and post-treatment sleep breathing related indicators(including AHI,the highest SpO2,the lowest SpO2,times of hypopnea and apnea,and duration of apnea),SBP,DBP,HR,airway resistance during exhalation and inspiration,and pulmonary dynamic compliance were compared between the two groups,and incidence of adverse reactions/complications was observed during treatment. Results(1)There was no statistically significant difference in AHI,the highest SpO2,the lowest SpO2,times of hypopnea or apnea,or duration of apnea between the two groups before treatment(P>0.05);after treatment,AHI,times of hypopnea and apnea in test group were statistically significantly lower than those in control group,the highest SpO2 and the lowest SpO2 in test group were statistically significantly higher than those in control group,duration of apnea in test group was statistically significantly shorter than that in control group(P<0.05).(2)There was no statistically significant difference in SBP,DBP,or HR between the two groups before treatment(P>0.05),while SBP,DBP and HR in test group were statistically significantly lower than those in control group after treatment(P<0.05).(3)There was no statistically significant difference in airway resistance during exhalation or inspiration,or pulmonary dynamic compliance between the two groups before treatment(P>0.05);after treatment,airway resistance during exhalation and inspiration in test group were statistically significantly lower than those in control group,while pulmonary dynamic compliance in test group was statistically significantly higher than that in control group(P<0.05).(4)No statistically significant difference of incidence of adverse reactions/complications was found between the two groups during treatment(P>0.05). Conclusion In patients with OSAS,continuous positive airway pressure ventilation can effectively perfect the sleep breathing related indicators,reduce the blood pressure,HR and airway resistance,improve the pulmonary dynamic compliance,with relatively high safety.
Background Continuous positive airway pressure ventilation is one of commonly used methods in treating obstructive sleep apnea syndrome(OSAS)on clinic,but long-term treatment of breathing machine may lead to functional decline of respiratory muscles,thus there is some controversy about the impact of continuous positive airway pressure ventilation on pulmonary function in patients with OSAS. Objective To investigate the impact of continuous positive airway pressure ventilation on airway resistance and pulmonary dynamic compliance in patients with OSAS. Methods A total of 123 patients with OSAS were selected in Shaanxi Provincial Armed Police Corps Hospital from March 2015 to February 2018,and they were divided into control group(n=60)and test group(n=63)according to therapeutic method. Based on conventional treatment,patients in control group received fudosteine tablets,while patients in test group received continuous positive airway pressure ventilation;both groups continuously treated for 2 weeks. Pre-and post-treatment sleep breathing related indicators(including AHI,the highest SpO2,the lowest SpO2,times of hypopnea and apnea,and duration of apnea),SBP,DBP,HR,airway resistance during exhalation and inspiration,and pulmonary dynamic compliance were compared between the two groups,and incidence of adverse reactions/complications was observed during treatment. Results(1)There was no statistically significant difference in AHI,the highest SpO2,the lowest SpO2,times of hypopnea or apnea,or duration of apnea between the two groups before treatment(P>0.05);after treatment,AHI,times of hypopnea and apnea in test group were statistically significantly lower than those in control group,the highest SpO2 and the lowest SpO2 in test group were statistically significantly higher than those in control group,duration of apnea in test group was statistically significantly shorter than that in control group(P<0.05).(2)There was no statistically significant difference in SBP,DBP,or HR between the two groups before treatment(P>0.05),while SBP,DBP and HR in test group were statistically significantly lower than those in control group after treatment(P<0.05).(3)There was no statistically significant difference in airway resistance during exhalation or inspiration,or pulmonary dynamic compliance between the two groups before treatment(P>0.05);after treatment,airway resistance during exhalation and inspiration in test group were statistically significantly lower than those in control group,while pulmonary dynamic compliance in test group was statistically significantly higher than that in control group(P<0.05).(4)No statistically significant difference of incidence of adverse reactions/complications was found between the two groups during treatment(P>0.05). Conclusion In patients with OSAS,continuous positive airway pressure ventilation can effectively perfect the sleep breathing related indicators,reduce the blood pressure,HR and airway resistance,improve the pulmonary dynamic compliance,with relatively high safety.
引文
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[16]余嘉欣,胡克.持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者难治性高血压的治疗作用[J].中华高血压杂志,2017,25(3):285-288.DOI:10.16439/j.cnki.1673-7245.2017.03.018.
[17]何权瀛.关于阻塞性睡眠呼吸暂停低通气综合征患者病情评估和治疗依从性评价的若干思考[J].中国呼吸与危重监护杂志,2017,16(5):425-426.DOI:10.7507/1671-6205.201709023.
[18]李泽萱,王晓,赵冠棋,等.阻塞性睡眠呼吸暂停致心肌损伤的临床和基础研究进展[J].中国全科医学,2018,21(33):4067-4071DOI:10.12114/j.issn.1007-9572.2018.00.262.
[19]新图叶.气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者心脏功能和血管内皮功能的影响[J].中国全科医学,2017,20(20):2459-2463.DOI:10.3969/j.issn.1007-9572.2017.20.007.
[20]曹毅,唐海红,何疆春,等.老年阻塞性睡眠呼吸暂停综合征与脑卒中的相关性研究[J].中华老年心脑血管病杂志,2015,17(8):834-836.DOI:10.3969/j.issn.1009-0126.2015.08.014.
[2]尹鲁平,刘晓燕.nCPAP改善老年阻塞性睡眠呼吸暂停综合征患者心血管症状应用研究[J].现代仪器与医疗,2015,21(5):55-57.
[3]MENDES M S,DOS SANTOS J M.Insomnia as an expression of obstructive sleep apnea syndrome--the effect of treatment with nocturnal ventilatory support[J].Rev Port Pneumol(2006),2015,21(4):203-208.DOI:10.1016/j.rppnen.2014.11.002.
[4]喻杨林,张力燕,业秀林,等.影响OSAS患者应用无创呼吸机依从性因素的分析及对策[J].临床肺科杂志,2015,20(10):1883-1886.DOI:10.3969/j.issn.1009-6663.2015.10.043.
[5]晋发,刘剑南,张秀伟,等.福多司坦联合常规降压药治疗阻塞性睡眠呼吸暂停综合征伴高血压的临床疗效[J].中国医院药学杂志,2017,37(13):1278-1280.DOI:10.13286/j.cnki.chinhosppharmacyj.2017.13.16.
[6]CAN M,UYGUR F,TANRIVERDI H,et al.Effect of continuous positive airway pressure(CPAP)therapy on IL-23 in patients with obstructive sleep apnea[J].Immunol Res,2016,64(5/6):1179-1184.DOI:10.1007/s12026-016-8869-8.
[7]汤思,周秀芳,胡克,等.中重度阻塞性睡眠呼吸暂停综合征临床表现的聚类分析及其意义[J].中华医学杂志,2016,96(30):2375-2379.DOI:10.3760/cma.j.issn.0376-2491.2016.30.003.
[8]胡丽叶,朱旅云,王秀慧,等.持续气道正压通气对合并阻塞性睡眠呼吸暂停综合征的糖尿病患者糖脂代谢的影响[J].中国慢性病预防与控制,2017,25(10):777-779.DOI:10.16386/j.cjpccd.issn.1004-6194.2017.10.016.
[9]邹阳,龚静蓉,宠宇峰.改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征的疗效及IL-6、瘦素和尿酸的影响[J].现代中西医结合杂志,2015,24(27):2974-2976.DOI:10.3969/j.issn.1008-8849.2015.27.004.
[10]万宗仁,陈炜,徐靖.正压通气对阻塞性睡眠呼吸暂停综合征患者夜间心脏自主神经调节功能的影响[J].中南医学科学杂志,2016,44(4):460-462.DOI:10.15972/j.cnki.43-1509/r.2016.04.025.
[11]KANBAY A,DEMIR N C,TUTAR N,et al.The effect of CPAPtherapy on insulin-like growth factor and cognitive functions in obstructive sleep apnea patients[J].Clin Respir J,2017,11(4):506-513.DOI:10.1111/crj.12365.
[12]贺茜,刘彦杉,曾桂芳,等.原发性高血压合并阻塞性睡眠呼吸暂停综合征患者血浆胱抑素C水平的临床分析[J].中国医师杂志,2016,18(12):1794-1800.DOI:10.3760/cma.j.issn.1008-1372.2016.12.009.
[13]肖立平,邓俊国,冯春晖,等.经鼻面罩持续气道内正压通气对阻塞性睡眠呼吸暂停低通气综合征伴心力衰竭患者心率变异性及心功能的影响研究[J].实用心脑肺血管病杂志,2017,25(1):56-59.DOI:10.3969/j.issn.1008-5971.2017.01.014.
[14]彭敏.祛瘀化痰配合耳压疗法治疗阻塞性睡眠呼吸暂停综合征疗效观察[J].现代中西医结合杂志,2016,25(21):2306-2309.DOI:10.3969/j.issn.1008-8849.2016.21.008.
[15]焦素芹,朱金妹,何俊,等.针刺疗法治疗阻塞性睡眠呼吸暂停低通气综合征临床疗效的Meta分析[J].实用心脑肺血管病杂志,2018,26(6):5-9.DOI:10.3969/j.issn.1008-5971.2018.06.002.
[16]余嘉欣,胡克.持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者难治性高血压的治疗作用[J].中华高血压杂志,2017,25(3):285-288.DOI:10.16439/j.cnki.1673-7245.2017.03.018.
[17]何权瀛.关于阻塞性睡眠呼吸暂停低通气综合征患者病情评估和治疗依从性评价的若干思考[J].中国呼吸与危重监护杂志,2017,16(5):425-426.DOI:10.7507/1671-6205.201709023.
[18]李泽萱,王晓,赵冠棋,等.阻塞性睡眠呼吸暂停致心肌损伤的临床和基础研究进展[J].中国全科医学,2018,21(33):4067-4071DOI:10.12114/j.issn.1007-9572.2018.00.262.
[19]新图叶.气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者心脏功能和血管内皮功能的影响[J].中国全科医学,2017,20(20):2459-2463.DOI:10.3969/j.issn.1007-9572.2017.20.007.
[20]曹毅,唐海红,何疆春,等.老年阻塞性睡眠呼吸暂停综合征与脑卒中的相关性研究[J].中华老年心脑血管病杂志,2015,17(8):834-836.DOI:10.3969/j.issn.1009-0126.2015.08.014.