国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2012年
16期
1230-1235
,共6页
姚菲菲%丁宁%黄汉鹏%张希龙
姚菲菲%丁寧%黃漢鵬%張希龍
요비비%정저%황한붕%장희룡
肥胖低通气综合征%阻塞性睡眠呼吸暂停综合征%气道正压通气
肥胖低通氣綜閤徵%阻塞性睡眠呼吸暫停綜閤徵%氣道正壓通氣
비반저통기종합정%조새성수면호흡잠정종합정%기도정압통기
Obesity hypoventilation syndrome%Obstructive sleep apnea syndrome%Positive airway pressure ventilation
目的 通过与双水平气道正压通气(BiPAP)模式比较,观察自动三水平正压通气(Auto-Trilevel PAP)模式对肥胖低通气综合征(OHS)合并中、重度阻塞性睡眠呼吸暂停综合征(OSAS)患者的疗效.方法 选择17例OHS合并中、重度OSAS患者,采用SOMNOvent auto-S型无创呼吸机(Weinmann Inc,Germany)治疗,比较3种不同通气模式的疗效,3种模式中吸气相气道正压(IPAP)值在每例患者中一致,均根据PaCO2滴定出,但呼气相气道正压(EPAP)不同,模式1和模式2均为固定的BiPAP模式,模式1的EPAP为能消除睡眠期鼾声的最低正压,而模式2的EPAP较模式1高3 cm H2O.模式3为Auto-Trilevel PAP模式,EPAP的初期压同模式1,但EPAP末期压(EEPAP)为自动调节升压,每种模式均给予一夜间8h的治疗,不同模式治疗间间隔两夜未给予治疗,分别比较与治疗前和不同模式治疗之间患者的睡眠期呼吸暂停低通气指数(AHI)、最低脉氧饱和度(MiniSpO2)、微觉醒指数、睡眠效率、治疗毕清晨PaCO2和治疗次日的ESS评分.结果 与治疗前相比,三种模式治疗中AHI值和微觉醒指数均显著降低(P＜0.01),而MiniSpO2和睡眠效率均明显增高(P＜0.01).此外治疗毕的清晨PaCO2和治疗结束当天的白日ESS评分也均明显降低(P＜0.01).但三种模式问比较显示模式3治疗时的睡眠效率最高,治疗毕的白日ESS评分最低.与模式1相比,模式3治疗时的AHI更低、MiniSpO2更高(P值均＜0.01),但治疗毕的清晨PaCO2差异无统计学意义(P＞0.05).与模式2相比,模式3治疗时的AHI和MiniSpO2差异无统计学意义(P值均＞0.05),但治疗毕的PaCO2显著降低(P＜0.01).结论 治疗OHS合并中、重度OSAS时Auto-Trilevel PAP模式在同时有效消除残余呼吸暂停低通气事件、纠正高碳酸血症、提高睡眠质量和降低白日嗜睡方面上较BiPAP模式更为优越.
目的 通過與雙水平氣道正壓通氣(BiPAP)模式比較,觀察自動三水平正壓通氣(Auto-Trilevel PAP)模式對肥胖低通氣綜閤徵(OHS)閤併中、重度阻塞性睡眠呼吸暫停綜閤徵(OSAS)患者的療效.方法 選擇17例OHS閤併中、重度OSAS患者,採用SOMNOvent auto-S型無創呼吸機(Weinmann Inc,Germany)治療,比較3種不同通氣模式的療效,3種模式中吸氣相氣道正壓(IPAP)值在每例患者中一緻,均根據PaCO2滴定齣,但呼氣相氣道正壓(EPAP)不同,模式1和模式2均為固定的BiPAP模式,模式1的EPAP為能消除睡眠期鼾聲的最低正壓,而模式2的EPAP較模式1高3 cm H2O.模式3為Auto-Trilevel PAP模式,EPAP的初期壓同模式1,但EPAP末期壓(EEPAP)為自動調節升壓,每種模式均給予一夜間8h的治療,不同模式治療間間隔兩夜未給予治療,分彆比較與治療前和不同模式治療之間患者的睡眠期呼吸暫停低通氣指數(AHI)、最低脈氧飽和度(MiniSpO2)、微覺醒指數、睡眠效率、治療畢清晨PaCO2和治療次日的ESS評分.結果 與治療前相比,三種模式治療中AHI值和微覺醒指數均顯著降低(P＜0.01),而MiniSpO2和睡眠效率均明顯增高(P＜0.01).此外治療畢的清晨PaCO2和治療結束噹天的白日ESS評分也均明顯降低(P＜0.01).但三種模式問比較顯示模式3治療時的睡眠效率最高,治療畢的白日ESS評分最低.與模式1相比,模式3治療時的AHI更低、MiniSpO2更高(P值均＜0.01),但治療畢的清晨PaCO2差異無統計學意義(P＞0.05).與模式2相比,模式3治療時的AHI和MiniSpO2差異無統計學意義(P值均＞0.05),但治療畢的PaCO2顯著降低(P＜0.01).結論 治療OHS閤併中、重度OSAS時Auto-Trilevel PAP模式在同時有效消除殘餘呼吸暫停低通氣事件、糾正高碳痠血癥、提高睡眠質量和降低白日嗜睡方麵上較BiPAP模式更為優越.
목적 통과여쌍수평기도정압통기(BiPAP)모식비교,관찰자동삼수평정압통기(Auto-Trilevel PAP)모식대비반저통기종합정(OHS)합병중、중도조새성수면호흡잠정종합정(OSAS)환자적료효.방법 선택17례OHS합병중、중도OSAS환자,채용SOMNOvent auto-S형무창호흡궤(Weinmann Inc,Germany)치료,비교3충불동통기모식적료효,3충모식중흡기상기도정압(IPAP)치재매례환자중일치,균근거PaCO2적정출,단호기상기도정압(EPAP)불동,모식1화모식2균위고정적BiPAP모식,모식1적EPAP위능소제수면기한성적최저정압,이모식2적EPAP교모식1고3 cm H2O.모식3위Auto-Trilevel PAP모식,EPAP적초기압동모식1,단EPAP말기압(EEPAP)위자동조절승압,매충모식균급여일야간8h적치료,불동모식치료간간격량야미급여치료,분별비교여치료전화불동모식치료지간환자적수면기호흡잠정저통기지수(AHI)、최저맥양포화도(MiniSpO2)、미각성지수、수면효솔、치료필청신PaCO2화치료차일적ESS평분.결과 여치료전상비,삼충모식치료중AHI치화미각성지수균현저강저(P＜0.01),이MiniSpO2화수면효솔균명현증고(P＜0.01).차외치료필적청신PaCO2화치료결속당천적백일ESS평분야균명현강저(P＜0.01).단삼충모식문비교현시모식3치료시적수면효솔최고,치료필적백일ESS평분최저.여모식1상비,모식3치료시적AHI경저、MiniSpO2경고(P치균＜0.01),단치료필적청신PaCO2차이무통계학의의(P＞0.05).여모식2상비,모식3치료시적AHI화MiniSpO2차이무통계학의의(P치균＞0.05),단치료필적PaCO2현저강저(P＜0.01).결론 치료OHS합병중、중도OSAS시Auto-Trilevel PAP모식재동시유효소제잔여호흡잠정저통기사건、규정고탄산혈증、제고수면질량화강저백일기수방면상교BiPAP모식경위우월.
Objective To observe the efficacy of auto-trilevel positive airway pressure (Auto-trilevel PAP) ventilation on patients with both obesity hypoventilation syndrome (OHS) and moderate to severe obstructive sleep apnea syndromes (OSAS) by comparison of fixed bilevel positive airway pressure (BiPAP) ventilation.Methods 17 patients with both OHS and moderate to severe OSAS were recruited.Three different positive airway pressure (PAP) modes issued by the ventilators (SOMNOvent auto-S,Weinmann Inc,Germany) were used for 8 hours per night with each mode at each night and two nights’interval without any treatment among different modes.In mode one,the EPAP issued by BiPAP was titrated as the Minimal positive pressure for disappearance of snoring.The same inspiratory positive airway pressure (IPAP) titrated by PaCO2 in mode 1 was used in mode 2 and 3 as well.However,the EPAP issued by BiPAP in mode 2 was 3 cm H2O higher than that in mode 1.In mode 3 with autotrilevel PAP,the beginning of EPAP was set the same as that in mode 1 while the end of EPAP (EEPAP) was automatically adjusted to elevate based on upper airway patency condition.Comparisons were made for parameters before and after treatment as well as among different ventilation modes. The following parameters were compared such as nocturnal apnea hypopnea index (AHI),Minimal SpO2 (MiniSpO2),arousal index,sleep efficiency,morning PaCO2 and daytime ESS.Results Compared with the parameters before ventilation therapies,there was a significant decrease in nocturnal AHI,arousal index,morning PaCO2 and daytime ESS,but a significant increase in nocturnal MiniSpO2 and sleep efficiency caused by all three modes of ventilation (all P ＜0.01).Comparison among three modes demonstrated that with the same IPAP,the mode 3 could result in the lowest arousal index,daytime ESS and the highest sleep efficiency.Comparison between mode 1 and 2 revealed there was a statistically lower AHI but higher MiniSpO2 and morning PaCO2 in mode 2 (all P ＜0.01).Compared with mode 1,in mode 3 there was a lower AHI,higher MiniSpO2 (all P ＜0.01 ),but no significant difference in morning PaCO2 at the end of therapy.Compared with mode 2,in mode 3 there was a significant lower morning PaCO2 ( P ＜0.01),but no significant difference in AHI and MiniSpO2.Conclusions Auto-trilevel PAP ventilation is superior over fixed BiPAP ventilaiton for treatment of OHS with coexisting moderate to severe OSAS,since this novel PAP mode can achieve a higher efficacy in simultaneous removal of residual apnea hypopnea events and correction of hypercapnia as well as in achieving a higher sleep quality and lower daytime sleepiness.
