中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
40期
3273-3276
,共4页
王碧瑛%韩芳%李清华%陈晓%李静%安培%赵龙%张雪丽%陈公平
王碧瑛%韓芳%李清華%陳曉%李靜%安培%趙龍%張雪麗%陳公平
왕벽영%한방%리청화%진효%리정%안배%조룡%장설려%진공평
睡眠呼吸暂停,阻塞性%血氧测定法%诊断%连续气道正压通气
睡眠呼吸暫停,阻塞性%血氧測定法%診斷%連續氣道正壓通氣
수면호흡잠정,조새성%혈양측정법%진단%련속기도정압통기
Sleep apnea%obstructive%Oximetry%Diagnosis%Continuous positive airway pressure
目的 探讨腕式脉搏血氧仪对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的诊断价值,评估持续气道正压通气(CPAP)对患者的疗效.方法 连续纳入2013年1月至2014年3月在福建医科大学附属第一医院呼吸与危重症医学科及北京大学人民医院呼吸与危重症医学科睡眠中心就诊并确诊为OSAHS的244例患者,根据呼吸暂停低通气指数(AHI)分为轻、中、重度组.对比3组患者在CPAP治疗前后的夜间脉搏升高指数(NPEI,即每小时睡眠中心率波动>6次/min的次数)、平均心率、标准差心率;同时对心率相关指标与AHI进行Spearman相关性分析,寻找反映心率相关的最佳指标,并与AHI进行比较,计算其敏感度、特异度,绘制受试者工作特征(ROC)曲线.结果 轻、中、重度组患者CPAP治疗后的NPEI均显著低于治疗前(15.4 ±12.4比19.4 ±13.3、15.4 ±9.1比24.1 ±11.9、21.9 ±14.8比48.8 ±20.3,均P<0.05);患者的平均心率、心率标准差、NPEI与AHI呈显著相关(r=0.334、0.337、0.660,均P<0.05);ROC曲线显示以NPEI≥30次/h为诊断指标时,其诊断OSAHS的敏感度、特异度分别为68.0%、73.0%.结论 腕式脉搏血氧仪可作为OSAHS有效的初筛手段,而且能从监测NPEI变化来评价CPAP治疗效果.
目的 探討腕式脈搏血氧儀對阻塞性睡眠呼吸暫停低通氣綜閤徵(OSAHS)的診斷價值,評估持續氣道正壓通氣(CPAP)對患者的療效.方法 連續納入2013年1月至2014年3月在福建醫科大學附屬第一醫院呼吸與危重癥醫學科及北京大學人民醫院呼吸與危重癥醫學科睡眠中心就診併確診為OSAHS的244例患者,根據呼吸暫停低通氣指數(AHI)分為輕、中、重度組.對比3組患者在CPAP治療前後的夜間脈搏升高指數(NPEI,即每小時睡眠中心率波動>6次/min的次數)、平均心率、標準差心率;同時對心率相關指標與AHI進行Spearman相關性分析,尋找反映心率相關的最佳指標,併與AHI進行比較,計算其敏感度、特異度,繪製受試者工作特徵(ROC)麯線.結果 輕、中、重度組患者CPAP治療後的NPEI均顯著低于治療前(15.4 ±12.4比19.4 ±13.3、15.4 ±9.1比24.1 ±11.9、21.9 ±14.8比48.8 ±20.3,均P<0.05);患者的平均心率、心率標準差、NPEI與AHI呈顯著相關(r=0.334、0.337、0.660,均P<0.05);ROC麯線顯示以NPEI≥30次/h為診斷指標時,其診斷OSAHS的敏感度、特異度分彆為68.0%、73.0%.結論 腕式脈搏血氧儀可作為OSAHS有效的初篩手段,而且能從鑑測NPEI變化來評價CPAP治療效果.
목적 탐토완식맥박혈양의대조새성수면호흡잠정저통기종합정(OSAHS)적진단개치,평고지속기도정압통기(CPAP)대환자적료효.방법 련속납입2013년1월지2014년3월재복건의과대학부속제일의원호흡여위중증의학과급북경대학인민의원호흡여위중증의학과수면중심취진병학진위OSAHS적244례환자,근거호흡잠정저통기지수(AHI)분위경、중、중도조.대비3조환자재CPAP치료전후적야간맥박승고지수(NPEI,즉매소시수면중심솔파동>6차/min적차수)、평균심솔、표준차심솔;동시대심솔상관지표여AHI진행Spearman상관성분석,심조반영심솔상관적최가지표,병여AHI진행비교,계산기민감도、특이도,회제수시자공작특정(ROC)곡선.결과 경、중、중도조환자CPAP치료후적NPEI균현저저우치료전(15.4 ±12.4비19.4 ±13.3、15.4 ±9.1비24.1 ±11.9、21.9 ±14.8비48.8 ±20.3,균P<0.05);환자적평균심솔、심솔표준차、NPEI여AHI정현저상관(r=0.334、0.337、0.660,균P<0.05);ROC곡선현시이NPEI≥30차/h위진단지표시,기진단OSAHS적민감도、특이도분별위68.0%、73.0%.결론 완식맥박혈양의가작위OSAHS유효적초사수단,이차능종감측NPEI변화래평개CPAP치료효과.
Objective To explore the value of pulse oximetry for diagnosing obstructive sleep apnea hypopnea syndrome (OSAHS) and evaluation of the effect of the continuous positive airway pressure (CPAP) therapy.Methods From January 2013 to March 2014, 244 OSAHS patients admitted to department of respiratory and critical care medicine of the first affiliated hospital of Fujian Medical University and department of respiratory and critical care medicine of People's Hospital of Peking University were recruited.According to apnea-hypopnea index (AHI) , all patients were divided into mild , moderate and severe groups.The differences in pulse-associated indicators [ nocturnal pulse elevation index (NPEI) , namely counts of heart rate (HR) variation >6 bpm/h, average HR and standard deviation of HR ] were compared among three groups before and after CPAP therapy.Spearman correlation analysis between pulse-associated indicators and AHI was performed to explore the optimal indicator.Receiver operating characteristic (ROC) curve were conducted and sensitivity and specificity were obtained.Results NPEI after CPAP treatment were significantly lower than before among all the three groups (mild group 15.4 ± 12.4 vs 19.4 ±13.3, moderate group 15.4 ±9.1 vs 24.1 ±11.9, severe group 21.9 ±14.8 vs 48.8 ± 20.3, all P<0.05);there were significant correlations of AHI with average HR , standard deviation of HR and NPEI (r=0.334, 0.337 and 0.660, respectively) (all P <0.05); ROC curve showed a NPEI of 30beat per hour had a sensitivity of 68.0%and a specificity of 73.0%in diagnosing OSAHS.Conclusion Nocturnal oximetry could be a useful tool for screening OSAHS in clinical practice , and the NPEI can evaluate the efficacy of the CPAP therapy.
