CAJ | 학술논문

目的探讨单纯慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者与重叠综合征患者夜间低氧情况及长期呼吸机无创通气治疗对重叠综合征(慢性阻塞性肺疾病患者合并睡眠呼吸暂停低通气综合征)肺功能和血氧的影响.方法 140例稳定期COPD患者均进行夜间氧饱和度监测和肺功能检测,其中重叠综合征患者67例,观察10例重叠综合征患者单纯氧疗和氧疗+呼吸机无创通气治疗前后夜间血氧情况,对5例长期夜间无创通气治疗的重叠综合征患者进行1年动态夜间血氧和肺通气功能监测.结果 10例重叠综合征患者单纯氧疗及氧疗加呼吸机治疗比较,组间在动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、夜间最低氧饱和度(LSaO2)、夜间平均氧饱和度(MSaO2)、血氧饱和度低于90%的时间占总记录时间的百分比(SIT90%)等方面差异有统计学意义(P值均<0.05).长期(1年)无创通气治疗前后肺功能[呼吸峰流量(PEF)、肺活量(FVC)、FVC占预计值%、第1秒用力呼气容积(FEV1)、FEV1占预计值%]及夜间低氧指标(SIT90、MSaO2、LSaO2)明显改善(P值均<0.05).结果阻塞程度相同的重叠综合征患者夜间低氧比单纯COPD患者严重,长期无创通气治疗可以改善重叠综合征患者肺通气功能及夜间低氧,长期氧疗+无创通气治疗是重叠综合征患者的第一线治疗方案.
목적 탐토단순만성조새성폐질병(chronic obstructive pulmonary disease,COPD)환자여중첩종합정환자야간저양정황급장기호흡궤무창통기치료대중첩종합정(만성조새성폐질병환자합병수면호흡잠정저통기종합정)폐공능화혈양적영향.방법 140례은정기COPD환자균진행야간양포화도감측화폐공능검측,기중중첩종합정환자67례,관찰10례중첩종합정환자단순양료화양료+호흡궤무창통기치료전후야간혈양정황,대5례장기야간무창통기치료적중첩종합정환자진행1년동태야간혈양화폐통기공능감측.결과 10례중첩종합정환자단순양료급양료가호흡궤치료비교,조간재동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)、야간최저양포화도(LSaO2)、야간평균양포화도(MSaO2)、혈양포화도저우90%적시간점총기록시간적백분비(SIT90%)등방면차이유통계학의의(P치균<0.05).장기(1년)무창통기치료전후폐공능[호흡봉류량(PEF)、폐활량(FVC)、FVC점예계치%、제1초용력호기용적(FEV1)、FEV1점예계치%]급야간저양지표(SIT90、MSaO2、LSaO2)명현개선(P치균<0.05).결과 조새정도상동적중첩종합정환자야간저양비단순COPD환자엄중,장기무창통기치료가이개선중첩종합정환자폐통기공능급야간저양,장기양료+무창통기치료시중첩종합정환자적제일선치료방안.
Objective To study the nocturnal desaturation in patients with overlap syndrome and chronic obstructive pulmonary disease (COPD) alone, the long-term effects of pulmonary function and nocturnal desaturation of noninvasive ventilation (NIV) therapy in overlap syndrome. Methods One hundred and forty patients with stable COPD were under home pulse oximeter testing and respiratory function testing, from overnight pulse oximetry, the percentage of time spent at SaO2 below 90% (SIT90%),mean SaO2(MSaO2 %),the lowest SaO2 (LSaO2 %)and the number of desaturations≥4% per hour were calculated. All patients performed pulmonary function test have included 67 overlap syndrome. We observed that nocturnal ventilation therapy and oxygen therapy effects of nocturnal desaturation in 10 overlap syndrome. And observed nocturnal desaturation and pulmonary function of NIV therapy in 5 overlap syndrome followed-up during 1 years. Results There are significant difference on PaO2, PaCO2, LSaO2, MSaO2, SIT90 between oxygen treatment alone and oxygen therapy plus long-term NIV therapy ( P <0. 05). There are significant difference on FEV1 %, FVC, FVC% , PEF% SIT90, MSaO2, LSaO2 between NIV therapy infront and behind 1 year ( P <0. 01). Conclusions Patients with overlap have a more sleep-related O2 desaturation than do patients with COPD with the same degree of bronchial obstruction, the long-term NIV could improved the nocturnal desaturation and pulmonary function in overlap syndrome. Long-term O2 therapy in addition to long-term NIV is the first line treatment of overlap syndrome.