中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
11期
1002-1005
,共4页
隆玄%励雯静%李善群%施劲东%白春学
隆玄%勵雯靜%李善群%施勁東%白春學
륭현%려문정%리선군%시경동%백춘학
睡眠呼吸暂停,阻塞性%连续气道正压通气%治疗效果
睡眠呼吸暫停,阻塞性%連續氣道正壓通氣%治療效果
수면호흡잠정,조새성%련속기도정압통기%치료효과
Sleep apnea,obstructive%Continuous positive airway pressure%Treatment outcome
目的 探讨自动调节持续气通正压通气(auto CPAP)强化治疗对老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的疗效并分析影响其疗效的因素. 方法 用半随机对照方法将2009年4月至2011年4月在复旦大学附属中山医院鼾症和睡眠呼吸障碍诊治中心确诊的老年OSAHS患者分为强化治疗组(强化组,111例)与非强化治疗组(非强化组,109例),前者进行3d连续医院内强化治疗,治疗过程中对其进行针对性健康教育和指导,并根据其前一天治疗情况,对auto-CPAP呼吸机参数进行适当调整；后者仅进行1d的auto-CPAP治疗,辅以常规的健康教育和指导.比较两组患者的治疗参数包括呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(SaO2min)、夜间平均血氧饱和度(SaO2mean)及血氧饱和度＜90％的时间(tSaO2＜90％)、临床症状和不良反应发生率、Epworth嗜睡量表评分的差异,并对影响强化治疗的因素进行相关分析. 结果 强化组治疗后Epworth评分、AHI、tSaO2 ＜90％分别为(3.58±3.76)分、(7.85±6.53)次/h、(5.65±15.43) min,与非强化组治疗后(6.84±3.22)分、(10.42±7.27)次/h、(15.26±33.14) min相比显著减少(t=6.90、2.76、2.77,均P＜0.05)；强化组治疗后SaO2 min和SaO2 mean分别为(88.24±4.43)％和(96.57±1.53)％,与非强化组(83.28±5.06)％和(94.63±1.38)％比较显著增加(t=-7.74、-9.87,均P＜0.05)；临床症状及不良反应(除皮肤过敏)明显减轻(均P＜0.05).女性患者强化治疗后AHI(41.03±21.99)次/h比男性(38.59±20.83)次/h更低(t=2.13,P＜0.05),相关分析显示患者体质指数(BMI)、年龄、性别、治疗前病情程度与疗效相关(均P＜0.05). 结论 医院内强化治疗能显著改善老年OSAHS患者病情,降低临床症状及不良反应发生率,有助于提高老年OSAHS患者治疗依从性,强化治疗疗效与患者BMI、年龄、性别及治疗前病情程度等因素有关.
目的 探討自動調節持續氣通正壓通氣(auto CPAP)彊化治療對老年阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)患者的療效併分析影響其療效的因素. 方法 用半隨機對照方法將2009年4月至2011年4月在複旦大學附屬中山醫院鼾癥和睡眠呼吸障礙診治中心確診的老年OSAHS患者分為彊化治療組(彊化組,111例)與非彊化治療組(非彊化組,109例),前者進行3d連續醫院內彊化治療,治療過程中對其進行針對性健康教育和指導,併根據其前一天治療情況,對auto-CPAP呼吸機參數進行適噹調整；後者僅進行1d的auto-CPAP治療,輔以常規的健康教育和指導.比較兩組患者的治療參數包括呼吸暫停低通氣指數(AHI)、夜間最低血氧飽和度(SaO2min)、夜間平均血氧飽和度(SaO2mean)及血氧飽和度＜90％的時間(tSaO2＜90％)、臨床癥狀和不良反應髮生率、Epworth嗜睡量錶評分的差異,併對影響彊化治療的因素進行相關分析. 結果 彊化組治療後Epworth評分、AHI、tSaO2 ＜90％分彆為(3.58±3.76)分、(7.85±6.53)次/h、(5.65±15.43) min,與非彊化組治療後(6.84±3.22)分、(10.42±7.27)次/h、(15.26±33.14) min相比顯著減少(t=6.90、2.76、2.77,均P＜0.05)；彊化組治療後SaO2 min和SaO2 mean分彆為(88.24±4.43)％和(96.57±1.53)％,與非彊化組(83.28±5.06)％和(94.63±1.38)％比較顯著增加(t=-7.74、-9.87,均P＜0.05)；臨床癥狀及不良反應(除皮膚過敏)明顯減輕(均P＜0.05).女性患者彊化治療後AHI(41.03±21.99)次/h比男性(38.59±20.83)次/h更低(t=2.13,P＜0.05),相關分析顯示患者體質指數(BMI)、年齡、性彆、治療前病情程度與療效相關(均P＜0.05). 結論 醫院內彊化治療能顯著改善老年OSAHS患者病情,降低臨床癥狀及不良反應髮生率,有助于提高老年OSAHS患者治療依從性,彊化治療療效與患者BMI、年齡、性彆及治療前病情程度等因素有關.
목적 탐토자동조절지속기통정압통기(auto CPAP)강화치료대노년조새성수면호흡잠정저통기종합정(OSAHS)환자적료효병분석영향기료효적인소. 방법 용반수궤대조방법장2009년4월지2011년4월재복단대학부속중산의원한증화수면호흡장애진치중심학진적노년OSAHS환자분위강화치료조(강화조,111례)여비강화치료조(비강화조,109례),전자진행3d련속의원내강화치료,치료과정중대기진행침대성건강교육화지도,병근거기전일천치료정황,대auto-CPAP호흡궤삼수진행괄당조정；후자부진행1d적auto-CPAP치료,보이상규적건강교육화지도.비교량조환자적치료삼수포괄호흡잠정저통기지수(AHI)、야간최저혈양포화도(SaO2min)、야간평균혈양포화도(SaO2mean)급혈양포화도＜90％적시간(tSaO2＜90％)、림상증상화불량반응발생솔、Epworth기수량표평분적차이,병대영향강화치료적인소진행상관분석. 결과 강화조치료후Epworth평분、AHI、tSaO2 ＜90％분별위(3.58±3.76)분、(7.85±6.53)차/h、(5.65±15.43) min,여비강화조치료후(6.84±3.22)분、(10.42±7.27)차/h、(15.26±33.14) min상비현저감소(t=6.90、2.76、2.77,균P＜0.05)；강화조치료후SaO2 min화SaO2 mean분별위(88.24±4.43)％화(96.57±1.53)％,여비강화조(83.28±5.06)％화(94.63±1.38)％비교현저증가(t=-7.74、-9.87,균P＜0.05)；림상증상급불량반응(제피부과민)명현감경(균P＜0.05).녀성환자강화치료후AHI(41.03±21.99)차/h비남성(38.59±20.83)차/h경저(t=2.13,P＜0.05),상관분석현시환자체질지수(BMI)、년령、성별、치료전병정정도여료효상관(균P＜0.05). 결론 의원내강화치료능현저개선노년OSAHS환자병정,강저림상증상급불량반응발생솔,유조우제고노년OSAHS환자치료의종성,강화치료료효여환자BMI、년령、성별급치료전병정정도등인소유관.
Objective To investigate the efficacy of the hospital intensive treatment by auto-CPAP on elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to analyse the possible factors related to the effectiveness.Methods Subjects were selected from elderly OSAHS patients over 60 years old.The eligible subjects were divided into intensive treatment group and non-intensive treatment group (non-ITG).Patients in intensive treatment group were intensively treated using auto-CPAP for 3 consecutive days,assisted with targeted health education and guidance,and making proper adjustments to parameters of the auto-CPAP according to treatment outcomes at the previous day.But those in non-intensive treatment group were just treated with auto-CPAP for only 1 day,supplemented by regular health education and guidance.The apnea-hypopnea index (AHI),minimum oxygen saturation (SaO2min),mean oxygen saturation (SaO2mean) and the time spent at SaO2 lower than 90％ (tSaO2＜90％),the occurrence of clinical symptoms and adverse effect,Epworth sleepiness scale(ESS) were compared between both groups.The correlation analyses were also conducted.Results ESS (3.58±3.76 vs.6.84 ± 3.22),AHI [(7.85±6.53) time/h vs.(10.42±7.27) time/h] and tSaO2＜90％[(5.65±15.43) min vs.(15.26±33.14) min] were lower(t=6.902,2.760,2.765,allP＜0.05),while SaO2mean [(96.57±1.53)％ vs.(94.63±1.38)％] and SaO2min [(88.24±4.43)％ vs.(83.28±5.06)％]were higher(t=-9.870,-7.740,both P＜0.05)in intensive treatment group than in non intensive treatment group.The occurrences of clinical symptoms and adverse effect (except for skin allergy) were decreased in intensive treatment group versus non-ITG (all P＜0.05).The AHI after intensive treatment was decreased in females versus males [(7.85±5.19) times /h vs.(11.27±7.78) times/h,t=2.133,P＜0.05].BMI,age,gender and the state of OSAHS were correlated to AHI,SaO2 mean,SaO2 min and tSao2＜90％ after intensive treatment (all P＜0.05).Conclusions The hospital intensive treatment can improve the clinical results and decrease the occurrences of clinical symptoms and adverse effect for elderly OSAHS patients,and is expected to improve therapy compliance,and its curative efficacy is correlated to BMI,age,gender and state of OSAHS before therapy.
