慢性阻塞性肺疾病及阻塞性睡眠呼吸暂停低通气综合征患者呼吸阻抗和睡眠呼吸紊乱的研究

目的 分析慢性阻塞性肺疾病(COPD)、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)及重叠综合征(overlap syndrome)患者气道阻力和睡眠呼吸紊乱的特点. 方法 选取已确诊为COPD 11例(COPD组)、OSAHS 15例(OSAHS组)、重叠综合征4例(重叠组)和健康对照10例(对照组),所有研究对象均行夜间睡眠多导图监测和气道阻力测定,分析各组气道阻塞的部位及程度. 结果 COPD组、OSAHS组及重叠组的呼吸总阻抗(Zrs)、呼吸总黏性阻力(R5)、中心阻力(Rc)、周边阻力(RP)均显著高于对照组(均P<0.05);COPD组及重叠组的Zrs、R5、R5-20、Fres、X5、Rc、Rp阻力均显著高于OSAHS组(均P<0.05);OSAHS 组的R20、Rc均高于COPD组(均P<0.05).COPD患者FEV1/Pre%与睡眠效率成正相关(r=0.632,P<0.05).与觉醒次数、低氧时间和氧减指数成负相关(r值分别为-0.672、-0.868、-0.846,均P<0.05). 结论 COPD、OSAHS和重叠综合征患者的中心气道阻力和外周气道阻力均有升高;COPD患者以外周气道阻力增加为主.OSAHS患者以中心气道阻力增加为主;重叠综合征患者的呼吸总阻抗,呼吸道总黏性阻力比COPD和OSAHS患者更高.COPD患者夜间睡眠呼吸紊乱程度与病情严重程度的关系密切,其中低氧时间和氧减指数为较好的反映指标.

Features of respiratory impedance between COPD and OSAHS patients

Objective To study the characteristics of respiratory impedance in patients with chronic obstructive pulmonary disease (COPD),obstructive sleep apnea hypopnea syndrome (OSAHS).Methods The respiratory impedance were measured by Impulse Oscillometry(IOS) technique and polysomnography(PSG) were done synchronously in 11 COPD patients,15 OSAHS patients,4 overlap syndrome patients(COPD+OSAHS) and 10 control group. Results Zrs、R5、Rc and RP in COPD group,OSAHS group and COPD+OSAHS group were higer than those in contml group.Zrs、R5、R5-20、Fres.Rc and Rp in COPD group and COPD+OSAHS group were significantly higerthan those in OSAHS group.R20 and Rc in OSAHS group were higher than those in COPD group and control group (P<0.05).Rc in OSAHS group was still significantly higher than that in COPD group (P<0.05). The level of sleep efficiency was positive correlated with FEVl/pre% of COPD(r=0.632),while the levels of rouse frequence (r=-0.672),time of SaO2 <90% (-0.868) and ODI (-0.846) were negative correlated with FEVl/pre% of COPD.Condusion For OSAHS patients, there is some dysfunction in peripheral airway tract;For COPD patients,ODI and time of SaO2<90% are good index for the severity of disease.