慢性阻塞性肺疾病夜间低氧血症患者氧疗方式的初步研究

【目的】研究慢性阻塞性肺疾病（COPD）患者夜间低氧的发生情况并探讨鼻导管及无创通气Bi-PAP方式吸氧对夜间低氧的疗效。【方法】220例稳定期COPD患者采用便携式初筛诊断仪进行睡眠监测，对存在夜间低氧患者行鼻导管及无创通气BiPAP方式进行氧疗下重复睡眠监测。【结果】夜间低氧血症的发生率为41．8％（92／220），夜间低氧与日间血氧饱和度（SaO2）相关；其中64％（59／92）患者经鼻导管氧疗效果好，而36％（33／92）患者改为无创通气BiPAP方式进行氧疗夜间低氧得以改善。【结论】COPD患者夜间睡眠时出现低氧或低氧血症加重，COPD与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）并存可加重夜间低氧血症，部分患者需要无创通气进行氧疗才能改善夜间低氧血症。     

慢性充血性心力衰竭患者伴睡眠呼吸暂停综合征的临床研究

目的探讨慢性充血性心力衰竭（CHF）伴睡眠呼吸暂停综合征（SAS）患者对心功能能响及其血清瘦素（1eptin）水平和肿瘤坏死因子a（TNF—a）的变化与临床意义。方法22例心力衰竭扈（CHF组）和18例心力衰竭伴睡眠呼吸暂停综合征患者（CHF＋SAS组）,进行多导睡眠图（PSG）检查;抽取静脉血测定血清瘦素（放射免疫法）及TNF—a,sTNFR1水平（ELISA法）。结果①CHF＋SAS缍眠呼吸暂停低通气指数（AHI）,SpO2〈90％的时间占总睡眠时间的百分数（TSaO2〈90％）均显著高CHF组（P〈0．01）;②CHF＋SAS组血清瘦素水平及TNF-a,sTNFR1水平显著高于CHF组（P〈0．01）结论慢性充血性心力衰竭伴睡眠呼吸暂停综合征患者反复的夜间血氧饱和度降低可加重病情,血瘦素及TNF-a可能参与上述的发病过程。     

面罩压力支持通气对改善慢性阻塞性肺病患者夜间低氧血症的效果观察

目的：观察面罩压力支持通气对改善慢性阻塞性肺病患者夜间低氧血症的效果。通过双相正压通气（ＢｉＰＡＰ）治疗夜间低氧血症，改善患者心肺功能。方法：对２０例伴夜间呼吸紊乱和低氧血症的慢性阻塞性肺病（ＣＯＰＤ）患者进行未吸氧、鼻导管吸氧、双相正压（ＢｉＰＡＰ）面罩压力支持通气３种状况下的夜间动脉血氧饱和度（ＳａＯ２）、心率、呼吸指标的监测。结果：未吸氧状况下患者夜间低氧血症明显，ＳａＯ２≤０．７２；ＢｉＰＡＰ面罩压力支持通气时ＳａＯ２的升高明显优于鼻导管吸氧，ＳａＯ２＞０．８５（Ｐ＜０．００１）。结论：ＢｉＰＡＰ面罩压力支持通气对改善ＣＯＰＤ患者夜间睡眠和呼吸紊乱，纠正低氧血症有明显作用。     

无创呼吸机治疗阻塞性呼吸暂停综合征的效果观察及护理

目的：探讨无创呼吸机持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停综合征（OSAS）的效果,寻求最佳护理对策。方法：对150例经整夜多导睡眠图（PSG）诊断为OSAS的患者在采用CPAP呼吸机治疗前与积极护理干预下行CPAP呼吸机治疗时两种不同状态下进行PSG监测并分析。结果：经CPAP治疗,并给予积极的护理干预后,呼吸障碍得到了明显的改善,呼吸暂停／低通气指数（AHI）、呼吸暂停次数、血氧饱和度等呼吸指数较治疗前明显改善（P〈0．01）。结论：CPAP呼吸机是治疗OSAS患者简单有效的方法,积极有效的护理是CPAP治疗成功的关键。     

睡眠呼吸暂停综合征602例的护理

目的：总结睡眠呼吸暂停综合征（SAHS）患者行多导睡眠监测（PSG）的护理经验。方法：对602例患者行整夜PSG，重视监测前护理；监测中密切观察病情及各项监测指标；监测后加强健康教育。结果：确诊SAHS患者586例，其中95％患者基本上掌握预防措施并对疾病有了正确认识，降低了并发症。结论：SAHS患者行PSG，优质的护理是保障监测和诊断准确性、安全性的关键，提高患者健康意识的有效措施。     

血氧饱和度监测对COPD夜间低氧血症的诊断价值

目的：探讨血氧饱和度监测对COPD夜间低氧血症的诊断价值。方法：应用便携式血氧饱和度仪,对98例COPD稳定期患者进行夜间血氧饱和度监测。结果：日间血氧饱和度＜90％的COPD患者,夜间血氧饱和度下降;日间血氧饱和度≥90％的COPD患者, 夜间血氧饱和度也降低。结论：血氧饱和度监测可以早期诊断COPD夜间低氧血症。     

老年人充血性心力衰竭与睡眠呼吸障碍的相关性调查及护理干预

目的了解老年人充血性心力衰竭与睡眠障碍的相关性。方法对2006年1月～2007年12月在我院心内科住院的老年心力衰竭患者50例进行多导睡眠监测（PSG）,对睡眠检测结果中的低通气指数（AHI）、夜间最低血氧饱和度（MinSaO2）、氧减饱和度指数（ODI）等结果进行分析。结果老年慢性充血性心力衰竭患者有着很高的睡眠呼吸障碍的发生率。严重的未经治疗的睡眠呼吸障碍可能影响左心室功能,并能加剧老年充血性心力衰竭患者的死亡。结论老年人充血性心力衰竭与睡眠障碍具有一定的相关性,重视对存在睡眠呼吸障碍的老年慢性充血性心衰患者的干预,能延缓心功能衰退的过程,提高生活质量。     

OSAH S患者多导睡眠图分析及PSG/CPAP夜间分段技术压力设定与疗效评估

【目的】分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的多导睡眠图(PSG)特征;评估PSG/CPAP夜间分段技术压力设定与治疗OSAHS的疗效。【方法】经多导睡眠仪检查并确诊OSAHS患者63例,设为观察组;确诊单纯鼾症(SS)21例,设为对照组。分析比较两组睡眠参数;对观察组OSAHS患者睡眠时行PSG/CPAP夜间分段技术压力设定及治疗1周,比较治疗前后临床表现及PSG参数变化。【结果】①与对照组相比,观察组OSAHS患者夜间睡眠结构明显紊乱,主要为睡眠潜伏期缩短、快速动眼相(REM)睡眠减少、浅睡眠相对增加、深睡眠减少、呼吸暂停或低通气次数增加、夜间平均及最低动脉血氧饱和度下降(P<0.05)。②经PSG/CPAP夜间分段技术压力设定与治疗后,观察组患者临床症状有明显改善;低通气指数(AHI)、夜间平均及最低动脉血氧饱和度、最长呼吸暂停时间较治疗前显著改善(P<0.05),治疗依从性好。【结论】OSAHS患者存在明显睡眠结构紊乱,PSG/CPAP夜间分段技术压力设定与治疗可使患者获得较满意的CPAP压力,可显著改善患者的临床症状及睡眠结构。     

多导睡眠监测169例分析

目的：通过多导睡眠临测（PSG）对睡眠呼吸障碍（SDB）患者诊断病情评估及治疗预后评估。方法：对169例（SDB）患者进行整夜（7h）多导睡眠监测，筛查出83例适合正墟通气治疗及手术治疗的患者，并在治疗后监测。结果：治疗后AHI均下降25％以上。结论：多导睡眠监测（PSG）是诊断OSAHS的金标准及预后疗效评估的必要手段。     

重叠综合征患者夜间缺氧状况及无创机械通气的疗效分析

【目的】探讨重叠综合征（OS）患者夜间缺氧状况及无创机械通气的疗效。【方法】对17例OS、20例阻塞型睡眠呼吸暂停低通气综合征（OSAHS）、19例慢性阻塞性肺疾病（COPD）患者分别进行全夜多导睡眠仪（PSG）检查，并对OS患者进行无创机械通气治疗。【结果】OS患者最低动脉血氧饱和度（SaO2L）显著低于COPD患者（P〈0．01），动脉血氧饱和度（SaO2）〈90％累计时间的百分率（SLT9%）显著高于COPD和0SAHS患者（P〈0．01），OS患者行无创机械通气后，夜间缺氧和呼吸暂停低通气指数（AHI）明显纠正（P〈0．01）。【结论】OS患者夜间缺氧较严重，采用无创机械通气治疗疗效显著。     

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Nocturnal oximetry is an attractive option for the diagnosis of obstructive sleep apnoea (OSA) syndrome because of its simplicity and low cost compared to polysomnography (PSG). The present study assesses nonlinear analysis of blood oxygen saturation (SaO(2)) from nocturnal oximetry as a diagnostic test to discriminate between OSA positive and OSA negative patients. A sample of 187 referred outpatients, clinically suspected of having OSA, was studied using nocturnal oximetry performed simultaneously with complete PSG. A positive OSA diagnosis was found for 111 cases, while the remaining 76 cases were classified as OSA negative. The following oximetric indices were obtained: cumulative time spent below a saturation of 90% (CT90), oxygen desaturation indices of 4% (ODI4), 3% (ODI3) and 2% (ODI2) and the delta index (Delta index). SaO(2) records were subsequently processed applying two nonlinear methods: central tendency measure (CTM) and Lempel-Ziv (LZ) complexity. Significant differences (p < 0.01) were found between OSA positive and OSA negative patients. Using CTM we obtained a sensitivity of 90.1% and a specificity of 82.9%, while with LZ the sensitivity was 86.5% and the specificity was 77.6%. CTM and LZ accuracies were higher than those provided by ODI4, ODI3, ODI2 and CT90. The results suggest that nonlinear analysis of SaO(2) signals from nocturnal oximetry could yield useful information in OSA diagnosis.     

Cardiac resynchronization therapy and obstructive sleep-related breathing disorder in patients with congestive heart failure

Objectives: To assess the impact of cardiac resynchronization therapy (CRT) with or without atrial overdrive pacing, on sleep‐related breathing disorder (SRBD). Introduction: CRT may have a positive influence on SRBD in patients who qualify for the therapy. Data are inconclusive in patients with obstructive SRBD. Methods: Consenting patients eligible for CRT underwent a baseline polysomnography (PSG) 2 weeks after implantation during which pacing was withheld. Patients with an apnea hypopnea index (AHI) ≥15 but <50 were enrolled and randomized to atrial overdrive pacing (DDD) versus atrial synchronous pacing (VDD) with biventricular pacing in both arms. Patients underwent two further PSGs 12 weeks apart. Results: Nineteen men with New York Heart Association class III congestive heart failure participated in the study (age 67.2 ± 7.5, Caucasian 78.9%, ischemic 73.7%). The score on Epworth Sleepiness Score was 7.3 ± 4.0, Pittsburgh Sleep Quality Index 7.4 ± 3.1, and Minnesota Living with Heart Failure Questionnaire 36.9 ± 21.9. There were no differences between the groups. At baseline, patients exhibited poor sleep efficiency (65.3 ± 16.6%) with nadir oxygen saturation of 83.5 ± 5.3% and moderate to severe SRBD (AHI 21.5 ± 15.3) that was mainly obstructive (central apnea index 3.3 ± 6.7/hour). On both follow‐up assessments, there was no improvement in indices of SRBD (sleep efficiency [68.3 ± 17.9%], nadir oxygen saturation of 82.8 ± 4.6%, and AHI 24.9 ± 21.9). Conclusion: In a cohort of elderly male CHF patients receiving CRT, CRT had no impact on obstructive SRBD burden with or without atrial overdrive pacing. (PACE 2011; 34:593–603)     

阻塞性睡眠呼吸暂停低通气综合征合并夜间心律失常患者对无创通气治疗的反应报告

目的:评估阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-hypopnea Syndrome,OSAHS)合并夜间缓慢型心律失常或心房颤动、房扑、频发室性早搏的患者行持续无创正压通气治疗后(Continuous Positive Airway Pressure,CPAP)临床症状、睡眠呼...     

Nocturnal oximetry: utility in the respiratory management of amyotrophic lateral sclerosis

OBJECTIVE: Current recommendations are to institute nocturnal nasal ventilation for amyotrophic lateral sclerosis patients with a forced vital capacity (FVC) of <50% of predicted normal. The purpose of this study was to determine whether this is appropriate. DESIGN: A total of 87 nocturnal oximetry evaluations were performed on 78 consecutive amyotrophic lateral sclerosis patients symptomatic for sleep-disordered breathing. Nocturnal oximetry measurements were compared for those with FVC >50% vs. those with FVC of <50% of normal. FVC was measured sitting and supine. RESULTS: A considerable number of these symptomatic patients manifested evidence of nocturnal hypoxemia as measured by oximetry. However, there was no significant difference between patients with sitting percentage-predicted FVC above and below 50% predicted in minimum oxygen saturation, mean oxygen saturation, percentage of time spent with oxygen saturation of <88%, and number of events per hour. There was no significant difference between patients with supine percentage-predicted FVC above and below 50% predicted in minimum oxygen saturation, mean oxygen saturation, percentage of time spent with oxygen saturation of <88%, and number of events per hour. CONCLUSION: The recommendation that FVC be <50% of normal is inappropriate for justifying introduction of nocturnal nasal ventilation. Many patients are symptomatic at higher FVC and manifest evidence of nocturnal hypoxemia. Nocturnal oximetry adds additional practical information for justifying earlier respiratory intervention for symptomatic patients.     

Carbon dioxide monitoring during long-term noninvasive respiratory support in children

Introduction  Routine monitoring of noninvasive respiratory support relies on nocturnal pulse oximetry and daytime arterial blood gases, without systematic nocturnal carbon dioxide recording. The aim of the study was to assess if overnight pulse oximetry and daytime blood gases are sufficiently accurate to detect nocturnal hypoventilation in children receiving long-term noninvasive respiratory support. Materials and methods  Pulse oximetry and carbon dioxide pressure measured by capillary arterialized blood gases and a combined transcutaneous carbon dioxide and pulse oximetry (PtcCO₂/SpO₂) monitor were compared in 65 patients (asthma, n = 16, recurrent bronchitis, n = 8, lung infection, n = 8, cystic fibrosis, n = 15, interstitial lung disease, n = 6, neuromuscular disease, n = 12). Daytime capillary arterialized blood gases and nocturnal recording of pulse oximetry and carbon dioxide by means of a combined PtcCO₂/SpO₂ monitor were performed in 50 other patients receiving nocturnal noninvasive respiratory support at home. Results  A correlation was observed between pulse oximetry (r = 0.832, P < 0.0001) and carbon dioxide pressure (r = 0.644, P < 0.0001) measured by capillary arterialized blood gases and the combined PtcCO₂/SpO₂ monitor. Twenty-one of the 50 patients (42%) on long-term noninvasive respiratory support presented nocturnal hypercapnia, defined by a PtcCO₂ value >50 mmHg, without nocturnal hypoxemia. Daytime capillary arterialized carbon dioxide levels were normal in 18 of these 21 patients. Conclusions  Nocturnal hypercapnia may occur in children receiving nocturnal noninvasive respiratory support at home. Nocturnal pulse oximetry and daytime arterial blood gases are not sufficiently accurate to diagnose nocturnal hypercapnia, underlying the importance of a systematic carbon dioxide monitoring in children receiving noninvasive respiratory support.     

无创通气对慢性阻塞性肺病患者夜间低氧血症的疗效观察

目的 观察双水平正压(BiPAP)无创通气治疗慢性阻塞性肺疾病(COPD)患者夜间低氧血症效果.方法 用多睡眠监测仪筛选出稳定期COPD夜间低氧患者82例,夜间睡眠用双水平正压无创通气治疗14天,第14天夜间用多睡眠监测仪再次进行睡眠监测.比较治疗前后的夜问血氧情况、睡眠结构变化.同时分别检测患者治疗前1天和治疗第14天的血清白细胞介素6(IL-6)情况.结果 稳定期COPD夜间低氧惠者夜间睡眠用无创通气治疗后,其平均血氧饱和度(SaO2)治疗前为(85.01±5.61)% vs第14天(92.12±6.81)%和最低SaO2治疗前为(65.23±6.91)%vs第14天(87.02±7.64)%明显增加,SaO2低于90%占睡眠总时间(T90)治疗前为(50.13±8.11)%vs第14天为(10.24±4.11)%明显减低.睡眠结构恢复正常.血清IL-6从治疗前(34.21±4.62)ng/L,治疗第14天减少为(18.60±6.42)ng/L(P<0.01).结论 无创通气是治疗COPD稳定期患者夜间低氧血症的有效方法.     

Clinical assessment of sleep among pediatric burn patients does not correlate with polysomnography

A vast amount of sleep research relies on subjective, observational assessments of wakefulness and sleep. The authors had the unique opportunity to compare observational and polysomnographic (PSG) determinations of sleep in a randomized crossover study of sleep-inducing medication in a group of pediatric burn patients. Pediatric burn patients were randomized to one of two regimens with sleep-inducing agents over a 2-week period. PSG was conducted for three consecutive nights each week, between 7-13 and 14-20 days postburn. The first night of monitoring each week was conducted without medication to serve as a baseline. Observational sleep assessments (awake, drowsy, or asleep) were simultaneously recorded every 15 minutes. PSG concordance with observation was based on the PSG sleep stages identified during the 2 minutes before the observations. If all 30-second epochs in the two minutes were designated as sleep stage 1 or above, then the PSG record was categorized as asleep. If all epochs demonstrated wakefulness, an awake status was recorded. Otherwise, the corresponding PSG finding was classified as mixed. Forty patients were enrolled into the study, with a mean age of 9.4 ± 0.6 years, TBSA burn of 50.1 ± 2.9%, and third-degree burn surface area of 43.2 ± 3.6%. Patients were judged according to observational criteria to be awake 9% of the nocturnal study period compared with PSG recordings indicating that the patients were awake 52.3% of the time. The correlation between observation and PSG was poor regardless of sleep agent administration. In conclusion, observational determination of wakefulness in pediatric burn patients correlates poorly with PSG; therefore, PSG is vital in the accurate evaluation of sleep-inducing medications among burn patients.     

椎-基动脉缺血发作与睡眠呼吸障碍

Therelationshipbetweencerebro－vasculardiseases（CVD）andSRBDhasattractedpeople’sattentionmoreandmoreinthepastyears．WepresentinthispapertherelationshipofVBIandSRBDwhichhasnoteverbeenreportedbefore．１Subjectandmethod１．１SubjectFortyfivepatients，male３２，female１３，withanageof２７～７４yearsandanaveragedurationofillnessof２．１years（５daysto１０years）．１．２Criteriaofdiagnosis犤１犦（１）Transientvertigoattacksaccom－paniedbyotherVBIsymptomssuchasdiplopia，scintillation，visua…     

PTT与PSG监测仪对诊断不同程度的阻塞性睡眠呼吸暂停低通气综合征受试者的比较分析

目的:与PSG比较,分析评价PTT监测仪对不同严重程度的阻塞性睡眠呼吸暂停低通气综合征疑诊患者的诊断价值。方法:选择141例打鼾患者,对其同时进行整夜多导睡眠监测(PSG)及PTT监测,并对其结果进行比较。以PSG所得的呼吸暂停低通气指数(PSG-AHI)>20作为OSAHS划分轻中度的临界点,将全体受试者分为轻度及以下受试者及中重度患者两组,比较其AHI结果。结果:PTT与PSG监测仪对呼吸暂停及低通气事件的结果均有较高的相关性,二者呼吸暂停的结果更为一致(r=0·932)。对轻度及以下受试者和中重度患者监测所得的AHI,二者均有较高的相关性,但中重度患者的AHI结果更为一致(r=0·951)。结论:PTT监测仪对OSAHS,尤其是中重度患者的诊断有相当高的准确性。