自动三水平正压通气治疗重叠综合征伴高碳酸血症的临床疗效
| 作者: |
1程忠,
1毛哲哲,
1胡彦峰,
1陈奎利,
1王慧玲,
1冯强
1 邯郸市中心医院呼吸内二科，河北 邯郸 056002 |
| 通讯: |
程忠
Email: 1143061876@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.06.016 |
摘要
目的：观察重叠综合征伴高碳酸血症患者应用自动三水平正压通气治疗的临床效果。方法：选择2016年1月至2017年3月就诊于邯郸市中心医院呼吸科的40例慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)合并中度以上阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome，OSAS)并伴有高碳酸血症的患者，随机分为对照组和观察组。对照组采用固定的双水平气道正压通气模式无创呼吸机治疗，观察组采用自动三水平气道正压通气模式，两组患者吸气相气道正压(inspiratory phase airway positive pressure，IPAP)相一致，呼气相气道正压(expiratory phase airway positive pressure，EPAP)不同。两组患者均在夜间睡眠时予7 d的呼吸机治疗，分别比较治疗前和治疗后患者睡眠期呼吸暂停低通气指数(apnea hypopnea index，AHI)，微觉醒指数，Epworth嗜睡评分(Epworth sleepiness score，ESS)、最低脉搏血氧饱和度、匹兹堡睡眠质量指数(Pittsburgh sleep quality index，PSQI)、炎症因子(TNF-α，IL-8，NF-кB)、血二氧化碳分压(partial pressure of carbon dioxide，PaCO2)。并比较两种不同正压通气模式的疗效。结果：两组患者治疗后的AHI、微觉醒指数、炎症因子(TNF-α，IL-8，NF-кB)，PaCO2，PSQI，ESS，与治疗前比较均明显降低，且差异有统计学意义(P<0.05)，且观察组与对照组相比，上述指标改善更佳，差异有统计学意义(P<0.05)；最低脉搏血氧饱和度与治疗前比较均明显升高，且差异有统计学意义(P<0.05)。结论：自动三水平正压通气治疗重叠综合征伴高碳酸血症患者显著改善患者通气及睡眠质量，纠正高碳酸血症，降低炎症因子(TNF-α，IL-8，NF-кB)的含量，疗效确切，可行性高，值得临床推广。
关键词：
阻塞性睡眠呼吸暂停综合征；慢性阻塞性肺病；炎症因子；正压通气
Clinical effect of automatic three-level positive pressure ventilation on overlapping syndrome with hypercapnia
CorrespondingAuthor: CHENG Zhong Email: 1143061876@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.06.016
Abstract
Objective: To observe and analyze the clinical effect of automatic three-level positive pressure ventilation in patients with concomitant syndromes and hypercapnia. Methods: A total of 40 patients with chronic obstructive pulmonary emphysema (COPD) were enrolled in the Department of Respiratory Medicine from January 2006 to March 2017. There was moderate obstructive sleep apnea syndrome (OSAS) with hypercapnia Patients were randomly divided into two groups, the control group using a fixed two-level positive airway pressure ventilation mode of non-invasive ventilator treatment, the observation group using automatic three-level positive airway pressure mode, the two groups of patients with inspiratory airway positive pressure (IPAP) consistent with the expiratory phase airway positive pressure (EPAP) is different. Comparison of the efficacy of two different positive pressure ventilation models; the patients in the two groups were treated with nocturnal sleep for 7 days. The apnea hypopnea index (AHI), micro awakening index, Epworth sleepiness score (ESS), minimum pulse oximetry, and Pittsburgh were compared between before and after treatment Sleep mass index (PSQI), inflammatory factors (TNF-α, IL-8, NF-кB), blood gas partial pressure of carbon dioxide (PaCO2). Results: AHI, micro arousal index, inflammatory factors (TNF-α, IL-8, NF-кB), PaCO2, PSQI and ESS were significantly decreased in the two groups after treatment, and the difference was statistically significant (P<0.05), and the observation group was better than the control group, the difference was statistically significant (P<0.05). The maximal pulse oxygen saturation was significantly higher than that before treatment, and the difference was statistically significant (P<0.05). Conclusion: Automatic three-level positive pressure ventilation can significantly improves ventilation and sleep quality, correct hypercapnia, and reduce inflammatory factors (TNF-α, IL-8, NF-кB) of the patients with patients with hyperosmolar syndrome, which is worthy of clinical promotion with the exact effect and high feasibility.
Keywords：
obstructive sleep apnea syndrome; chronic obstructive pulmonary emphysema; inflammatory factors; positive pressure ventilation