高原肺原性心脏病患者日间PaO_2>6.66kPa伴和不伴夜间减氧饱和与生存的关系

目的：探讨高原肺原性心脏病（肺心病）夜间减氧饱和（ＮＯＤ）与生存的关系。方法：对４６例日间动脉血氧分压（ＰａＯ２）＞６．６６ｋＰａ高原肺心病缓解期患者作日间动脉血气分析、肺功能和夜间血氧饱和度（ＳａＯ２）连续监测。结果：①与非ＮＯＤ组比较，ＮＯＤ组日间ＰａＯ２明显低于非ＮＯＤ组；ＰａＣＯ２明显高于非ＮＯＤ组；１秒钟用力呼气容积（ＦＥＶ１．０）／身高（Ｈｔ）、ＦＥＶ１．０／ＦＶＣ（用力肺活量）、Ｖ５０／Ｈｔ、Ｖ２５／Ｈｔ也明显低于非ＮＯＤ组；ＮＯＤ组睡眠平均ＳａＯ２和最低ＳａＯ２明显低于非ＮＯＤ组；平均生存时间和５年生存率ＮＯＤ组明显低于非ＮＯＤ组。②ＦＥＶ１．０／Ｈｔ、ＦＥＶ１．０／ＦＶＣ、Ｖ５０／Ｈｔ与生存时间也有相关性。③结论：高原肺心病ＮＯＤ与其预后有明显关系，ＦＥＶ１．０／Ｈｔ、ＦＥＶ１．０／ＦＶＣ、Ｖ５０／Ｈｔ对判断预后也有价值，建议此类患者应监测夜间ＳａＯ２及进行长期氧疗。

The relationship between daytime PaO 2>6.66kPa with and without nocturnal oxyhemoglobin desaturation and survival in chronic cor pulmonale patients at high altitude/

bjective:To investigate the relationship between nocturnal oxyhemoglobin desaturation and survial in patients with chronic cor pulmonale at high altitude.Methods:Daytime arterial blood geses,lung function and nocturnal sleep stage arterial oxygen saturation (SaO 2) were measured in 46 chronic cor pulmonale patients at high altitude (22603200m) with a daytime PaO 2>6.66kPa.According to results of nocturnal sleep stage SaO 2,the patients were divided into two groups:nocturnal oxyhemoglobin desaturation (NOD) group and nonNOD group.Results:Daytime PaO 2 in the NOD group was significantly lower than in the nonNOD (all P <0.01).Forced expiratory volume in one second (FEV 1 0 )/Ht,FEV 1 0 /FVC, 50 /Ht and 25 /Ht in the NOD group were significantly lower than those in the nonNOD( P <0 01 or P <0 05).Similarly,mean sleep time SaO 2,mean lowest SaO 2,survival time and fiveyear survival rate in the NOD group were significantly lower than those in the nonNOD( P <0 01 or P <0 05).In addition,survival time was significantly correlated with FEV 1 0 /Ht( r =0 458, P <0 01),FEV 1 0 /FVC( r =0 426, P <0 01) and 50 /Ht( r =0 367, P <0 05).Conclusions:The results suggest that chronic cor pulmonale patients with NOD at high altitude is associated with a shorter survival than those without NOD.Also,prognosis of chronic cor pulmonale at high altitude is related to changes in FEV 1 0 /Ht,FEV 1 0 /FVC and 50 /Ht.