中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
5期
271-274
,共4页
杨生岳%罗晓红%冯恩志%祁玉曙%刘睿年%殷和%张爱军%赵丽红
楊生嶽%囉曉紅%馮恩誌%祁玉曙%劉睿年%慇和%張愛軍%趙麗紅
양생악%라효홍%풍은지%기옥서%류예년%은화%장애군%조려홍
肺疾病,阻塞性%肺源性心脏病%阻塞性睡眠呼吸暂停低通气综合征%危险因素%高原
肺疾病,阻塞性%肺源性心髒病%阻塞性睡眠呼吸暫停低通氣綜閤徵%危險因素%高原
폐질병,조새성%폐원성심장병%조새성수면호흡잠정저통기종합정%위험인소%고원
Lung disease,obstructive%Chronic cor pulmonale%Obstructive sleep apnea-hypopnea syndrome%Risk factor%High altitude area
目的 探讨高原地区慢性肺源性心脏病急性加重期(AEHACCP)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的预后危险因素.方法 对66例AEHACCP合并OSAHS患者的颈围(Nc)、体质指数(BMI)、动脉血气、多导睡眠图监测参数与预后的关系进行单因素分析及多因素Logistic回归分析.结果 AEHACCP合并OSAHS患者的Nc≥45 cm、BMI≥28 kg/m2、动脉血氧分压(PaO2)≤40 mm Hg(1 mm Hg=0.133 kPa)、平均肺动脉压(mPAP)≥45 mm Hg、睡眠呼吸暂停低通气指数(AHI)≥40次/h、平均氧饱和度(MSaO2)≤0.70、睡眠SaO2<0.70占睡眠时间百分比(T70)≥50%、夜间基础氧饱和度与最低氧饱和度之差(△SaO2)≥0.20与其预后关系密切.经多因素Logistic回归分析,Nc≥45 cm[比值比(OR)6.781,95%可信区间(CI)1.153～17.502,P=0.007]、BMI≥28 kg/m2(OR 7.562,95%CI 1.012～23.457,P=0.004)、mPAP≥45 mm Hg(oR 6.991,95%CI 1.353～20.155,P=0.003)、AHI≥40次/h(OR 7.258,95%CI 1.526～18.022,P=0.006)、MSaO2≤0.70(OR 6.488,95%CI 1.562～26.878,P=0.008)、T70≥50%(OR5.593,95%CI 1.265～21.589,P=0.008)、ASaO2≥0.20(OR 6.551,95%CI 1.495～18.920,P=0.007)是影响AEHACCP合并OSAHS患者预后的独立危险因素.结论 Nc≥45 cm、BMI≥28 kg/m2、mPAP≥45 mm Hg、AHI≥40次/h、MSaO2≤0.70、T70≥50%、△SaO2≥0.20是导致AEHACCP合并0SAHS患者病死率增加的7个独立因素,在临床上要密切观察,并指导治疗,判断预后,降低病死率.
目的 探討高原地區慢性肺源性心髒病急性加重期(AEHACCP)閤併阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)患者的預後危險因素.方法 對66例AEHACCP閤併OSAHS患者的頸圍(Nc)、體質指數(BMI)、動脈血氣、多導睡眠圖鑑測參數與預後的關繫進行單因素分析及多因素Logistic迴歸分析.結果 AEHACCP閤併OSAHS患者的Nc≥45 cm、BMI≥28 kg/m2、動脈血氧分壓(PaO2)≤40 mm Hg(1 mm Hg=0.133 kPa)、平均肺動脈壓(mPAP)≥45 mm Hg、睡眠呼吸暫停低通氣指數(AHI)≥40次/h、平均氧飽和度(MSaO2)≤0.70、睡眠SaO2<0.70佔睡眠時間百分比(T70)≥50%、夜間基礎氧飽和度與最低氧飽和度之差(△SaO2)≥0.20與其預後關繫密切.經多因素Logistic迴歸分析,Nc≥45 cm[比值比(OR)6.781,95%可信區間(CI)1.153～17.502,P=0.007]、BMI≥28 kg/m2(OR 7.562,95%CI 1.012～23.457,P=0.004)、mPAP≥45 mm Hg(oR 6.991,95%CI 1.353～20.155,P=0.003)、AHI≥40次/h(OR 7.258,95%CI 1.526～18.022,P=0.006)、MSaO2≤0.70(OR 6.488,95%CI 1.562～26.878,P=0.008)、T70≥50%(OR5.593,95%CI 1.265～21.589,P=0.008)、ASaO2≥0.20(OR 6.551,95%CI 1.495～18.920,P=0.007)是影響AEHACCP閤併OSAHS患者預後的獨立危險因素.結論 Nc≥45 cm、BMI≥28 kg/m2、mPAP≥45 mm Hg、AHI≥40次/h、MSaO2≤0.70、T70≥50%、△SaO2≥0.20是導緻AEHACCP閤併0SAHS患者病死率增加的7箇獨立因素,在臨床上要密切觀察,併指導治療,判斷預後,降低病死率.
목적 탐토고원지구만성폐원성심장병급성가중기(AEHACCP)합병조새성수면호흡잠정저통기종합정(OSAHS)환자적예후위험인소.방법 대66례AEHACCP합병OSAHS환자적경위(Nc)、체질지수(BMI)、동맥혈기、다도수면도감측삼수여예후적관계진행단인소분석급다인소Logistic회귀분석.결과 AEHACCP합병OSAHS환자적Nc≥45 cm、BMI≥28 kg/m2、동맥혈양분압(PaO2)≤40 mm Hg(1 mm Hg=0.133 kPa)、평균폐동맥압(mPAP)≥45 mm Hg、수면호흡잠정저통기지수(AHI)≥40차/h、평균양포화도(MSaO2)≤0.70、수면SaO2<0.70점수면시간백분비(T70)≥50%、야간기출양포화도여최저양포화도지차(△SaO2)≥0.20여기예후관계밀절.경다인소Logistic회귀분석,Nc≥45 cm[비치비(OR)6.781,95%가신구간(CI)1.153～17.502,P=0.007]、BMI≥28 kg/m2(OR 7.562,95%CI 1.012～23.457,P=0.004)、mPAP≥45 mm Hg(oR 6.991,95%CI 1.353～20.155,P=0.003)、AHI≥40차/h(OR 7.258,95%CI 1.526～18.022,P=0.006)、MSaO2≤0.70(OR 6.488,95%CI 1.562～26.878,P=0.008)、T70≥50%(OR5.593,95%CI 1.265～21.589,P=0.008)、ASaO2≥0.20(OR 6.551,95%CI 1.495～18.920,P=0.007)시영향AEHACCP합병OSAHS환자예후적독립위험인소.결론 Nc≥45 cm、BMI≥28 kg/m2、mPAP≥45 mm Hg、AHI≥40차/h、MSaO2≤0.70、T70≥50%、△SaO2≥0.20시도치AEHACCP합병0SAHS환자병사솔증가적7개독립인소,재림상상요밀절관찰,병지도치료,판단예후,강저병사솔.
Objective To assess the prognostic risk factors in the patients with acute exacerbation of chronic cor pulmonale (AEHACCP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) in high altitude area.Methods The relations between neck circumference (No), body mass index (BMI), arterial blood gases, polysomnography (PSG) parameters and prognosis from 66 patients with AEHACCP and OSAHS (31 survivors, 35 non-survivors) were studied by one variable analysis and multivariable Logistic regression analysis.Results The results of one variable analysis showed that in patients with AEHACCP and OSAHS, Nc≥45 cm, BMI≥28 kg/m2, arterial oxygen partial pressure (PaO2)≤ 40 mm Hg (1 mm Hg=0.133 kPa), mean pulmonary arterial pressure (mPAP)≥45 mm Hg, apnea-hypopnea index(AHI)≥40 times/h, sleep mean arterial oxygen saturation (MSaO2)≤ 0.70, percentage of the duration of SaO2 <0.70 during sleep (T70)≥50 % and difference between basic and minimum SaO2 during sleep (△SaO2)≥0.20 were closely correlated with prognosis.The Logistic regression models showed that Nc≥45 cm [odds ratio (OR)= 6.781, 95% confidence interval (95%CI) = 1.153 - 17.502, P= 0.007], BMI≥28 kg/m2(OR=7.562, 95%CI=1.012 - 23.457, P = 0.004), mPAP≥ 45 mm Hg (OR = 6.991,95%CI=1.353 -20.155, P=0.003), AHI≥40 times/h (OR = 7.258, 95%CI = 1.526 - 18.022, P=0.006), MSaO2≤0.70 (0R=6.488, 95%CI=1.562- 26.878, P=0.008), T70≥50% (OR=5.593, 95%CI=1.265 - 21.589, P=0.008) and △SaO2≥0.20 (OR=6.551, 95%CI=1.495 - 18.920, P=0.007) were independent significant risk factors in prognosis of patients with AEHACCP and OSAHS.Conclusion The patients with AEHACCP and OSAHS, Nc≥45 cm, BMI ≥ 28 kg/m2, mPAP≥ 45 mm Hg, AHI≥40 times/h, MSaO2≤0.70, T70≥50% and ASaO2≥0.20 are risk factors leading to a rise in mortality.It is important to use these paramaters to guide clinical therapy, and to judge the prognosis so as to reduce the mortality of patients with AEHACCP and OSAHS by monitoring the above risk factors in clinical practice.
