呼气正压鼻塞治疗阻塞性睡眠呼吸暂停低通气综合征的安全性和疗效评估

目的 制作呼气正压鼻塞并评价其用于治疗睡眠呼吸暂停低通气综合征(OSAHS)的安全性及有效性。 方法 测量6名健康志愿者使用正压鼻塞时在不同呼气压下的呼出气CO₂分压(P_ETCO₂)。将14例中重度OSAHS患者随机分为两组,采用自身交叉对照的方法,分别应用正压鼻塞和CPAP治疗1周,给予1周洗脱时间,交换治疗方法后再各行治疗1周。在每次治疗结束末期给予PSG监测,比较二者的疗效差异。 结果 调节单向阀分别至5、10 cmH₂O, 测得P_ETCO₂与未治疗时差异无统计学意义(F=1.162, P=0.34)。两组在两阶段分别应用正压鼻塞和CPAP治疗后,AHI均显著降低(P<0.001),最低SaO₂,平均SaO₂均显著升高(P<0.001),两种治疗方法的疗效差异无统计学意义(P=0.830, 0672, 0.649; P=0.473, 0.636, 0.667)。 结论 正压鼻塞治疗OSAHS安全可靠,疗效显著,可进一步推广作为OSAHS临床治疗方法。

Efficacy and safety assessment of expiratory positive airway pressure rhinobyon for OSAHS therapy

Objective Evidence shows that CPAP therapy relying mainly on end-expiratory positive airway pressure (EEPAP) with OSAHS.Therefore,we designed expiratory positive airway pressure (EPAP) rhinobyon and made the efficacy and safety assessment.Methods Six volunteers were enrolled to measure the end-tidal carbon dioxide pressure (PErCO2) while being treated by EPAP rhinobyon under different expiratory pressure.Fourteen OSAHS patients (AHI ≥15/h by PSG) recruited were divided into two groups randomly and treated with CPAP and EPAP rhinobyon for a week respectively.After a week of washing out,the patients were applied with exchanged therapeutic methods for another week.The PSG was performed at the end of each week of treatment with device-on.Results There was no significant difference of PEr CO2 with EPAP therapies under different expiratory pressure and without any therapy (F =1.162,P =0.34).Among the 14 OSAHS patients in both groups,AHI decreased,minimum SaO2 and mean SaO2 increased significantly after treatment (P ＜ 0.001,respectively).There was no significant difference of the efficacy between EPAP rhinobyon and CPAP therapy (P =0.830,0672,0.649;P =0.473,0.636,0.667).Conclusion EPAP rhinobyon therapy was safe and reliable with significant efficacy for selected OSAHS patients.It could be promoted as the substitutive therapy for OSAHS in the future.