探讨阻塞性睡眠呼吸暂停低通气综合征的肺功能分析

目的：研究临床上阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS)治疗前后的肺功能特征。方法选取呼吸科、耳鼻喉专科门诊、住院部疑诊为OSAHS的患者66例进行肺功能检测并以Epworth嗜睡评分量表（ESS评分）≥9分进行初筛诊断，对于ESS评分＜9分，进行多导睡眠图监测后，58例确诊为OSAHS患者。将确诊并接受治疗的OSAHS患者30例作为实验组，因各种原因暂未接受治疗的OSAHS患者28例作为对照组，两组患者均在治疗前及半年后检测肺功能。探讨两组患者治疗前及半年后的肺功能指标变化情况。结果两组患者肺功能都存在一定程度的下降，实验组肺通气功能(用力肺活量、第1秒用力呼气量、1秒率、最大分钟通气量)、弥散功能指标（一氧化碳弥散量）有改善，但差异无统计学意义，对照组肺通气功能指标稍有降低，弥散功能指标差异无统计学意义。脉冲振荡技术（Impulse Oscillometry , IOS）测气道阻力（气道总阻力、中心气道阻力、上气道阻力、周围弹性阻力、响应频率），两组患者在治疗前均明显增高，半年后对照组患者气道阻力仍无明显改善，而实验组患者半年后气道阻力各指标明显降低，差异有统计学意义（P＜0.05）。结论对于临床上有嗜睡、头昏乏力、夜间打鼾、心慌憋闷等症状且肺功能检测以气道阻力增高为主的患者结合ESS评分及多导睡眠图监测有助于OSAHS的初步筛查及早期诊断；对OSAHS患者治疗效果及预后的评价应以IOS检测为主。

Discuss obstructive sleep apnea hypopnea syndrome (OSAHS) lung function analyze

Objective Studying the clinical characteristics of lung function before and after treatment of obstructive sleep ap-nea hypopnea syndrome (OSAHS) patients. Methods 66 cases with clinically suspected OSAHS in respiratory department and Oto-laryngology were tested by lung function and early diagnosed by Epworth sleepiness scale (ESS score). 58 cases were diagnosed OSAHS by polysomnogram. 30 cases OSAHS patients with treatment were set as the experimental group. 28 cases OSAHS patients without treatment for various reasons were set as the control group. Two groups of patients measured lung function before treatment and after six months and then discuss the change of lung function. Results Two groups of patients have a certain degree of decline in lung function. The lung ventilation(forced vital capacity. forced expiratory volume in one second. forced expiratory volume in one second to forced vital capacity ratio. maximal voluntary ventilation)and diffusion function(diffusion capacity for carbon monox-ide of the Lung,DLCO) of experimental group have improved, but there was no significant difference. The lung ventilation function of control group is slightly lower, and the diffusion function of control group there was no significant difference.The airway resis-tance of the two groups that measured by the impulse oscillometry(IOS)(the total airway resistance.central airway resistance. The air-way resistance.the elastic resistance around. resonant frequence,Fres) were significantly high before treatment. After six months, the airway resistance of the control group patients still has no obvious improvement, but the experimental group patients decreased obviously (P<0.05). Conclusion For patients that have drowsiness, dizziness, fatigue, snoring and palpitate and high airway resis-tance measured by lung function, the ESS score and polysomnogram help to preliminarily screen and early diagnose of OSAHS. The evaluation of treatment effect and prognosis of patients with OSAHS should give priority to with the IOS.