轻-中度低氧血症慢性阻塞性肺疾病患者夜间血氧观察

【目的】调查轻-中度低氧血症慢性阻塞性肺疾病（chronic obstructive lung disease,COPD）患者夜间缺氧情况。【方法】对148例白天轻-中度低氧血症的稳定期COPD患者（PaO256~69 mmHg）,进行多导睡眠监测,分析其缺氧人群分布情况。【结果】入选的COPD患者平均肺功能分级重度不全[FEV1（37%±10%）predicted]、伴有白天轻度缺氧[PaO2（65±3）mmHg]。其中66名患者符合夜间无缺氧的规定,定为Ⅰ组;48名患者符合夜间有缺氧的规定,定为Ⅱ组;34名患者符合夜间有缺氧合并睡眠呼吸暂停的规定,定为Ⅲ组。睡眠监测前SaO2分别为：Ⅰ组（90±1）%、Ⅱ组（89±2）%、Ⅲ组（88±3）%,比较无统计学差异（P=0.09）;但是监测期平均氧饱和度（SaO2）分别为：Ⅰ组（89±2）%、Ⅱ组（86±3）%、Ⅲ组（85±2）%,Ⅰ组比Ⅱ组、Ⅲ组显著高（P〈0.01）。【结论】在白天轻-中度低氧血症的中-重度COPD患者人群中,有很大一部分存在夜间明显单纯缺氧或缺氧合并睡眠呼吸暂停,有必要对此类患者进行常规的夜间睡眠监测筛查,以为患者制定正确的长期治疗计划。

Investigation on nocturnal anoxia in COPD patients with mild-to-moderate daytime hypoxemia

【Objective】To investigate the nocturnal anoxia in COPD patients with mild-to-moderate daytime hypoxemia.【Methods】A multiplying channe Sleep Monitoring in 148 stable patients with COPD and mild-to-moderate daytime hypoxemia（PaO2 56~69 mmHg） was conducted,and the population distribution of nocturnal oxygen desaturation was analyze.【Results】The 148 patients completed the study,on average,had severe COPD[FEV1（37%±10%）predicted] and moderate daytime hypoxemia [PaO2（65±3） mmHg].among the total sixty-six patients（45%） agreed the define of no signifcant nocturnal desaturation（Ⅰgroup）,forty-eight patients（32%）are agreed the define of signi ficant nocturnal desaturation without evidence of sleep apnea（Ⅱgroup）,thirty-four agreed the define of signifcant nocturnal desaturation with evidence of sleep apnea（Ⅲgroup）.The baseline saturation（SaO2） before polysomnographic recordings were（90±1）% inⅠgroup,（89±2）% inⅡgroup and（88±3）% in Ⅲ group（P = 0.09） respectively,but the average saturation（SaO2） during polysomnographic recordings period were discriminatory,Ⅰgroup had relatively higher SaO2（89±2）% than that of Ⅱor Ⅲgroup[（86± 3）% or（85±2）%,P 0.01]【.Conclusions】A significant proportion of patients with moderate-to-severe COPD do not qualify for home oxygen therapy based on their daytime PaO2 have nocturnal oxygen desaturation with or without evidence of sleep apnea.It is necessary to proceed routine sleep monitoring for screening this population,in order to enact correct long term treatment plan.