摘要
目的证实不稳定的呼吸调控对持续气道正压通气(PAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)短期效果的影响。方法 42例成人OSAHS患者,男性39例,女性3例,行多道睡眠图(PSG)监测、肺功能检查及环路增益评估。环路增益评估较高代表呼吸调控不稳定。行自动单水平正压通气机进行短期治疗,分析疗效与患者睡眠指标、环路增益等因素的关系。佩戴PAP治疗时呼吸暂停低通气指数(AHI)仍≥10次/h者视为疗效不佳,分析疗效不佳患者的临床特点。结果研究对象平均年龄(40±8)岁,AHI 68.2[42.9,81.0]次/h,环路增益值中位数为0.63[0.47,0.81]。疗效较好者具有较低的环路增益,即呼吸调控较稳定(P=0.035),较高的肺总量实际值/预计值(P=0.019)和较低的混合性呼吸暂停指数(P=0.004)。26例环路增益值>0.6、即呼吸调控相对不稳定的患者中,8例(30.8%)戴机后平均AHI<5次/h,视为疗效好;9例(34.6%)5次/h≤AHI<10次/h,视为疗效尚可;9例(34.6%)AHI≥10次/h,视为疗效不佳。16例环路增益值<0.6、即呼吸调控较为稳定的患者中,无戴机疗效不佳者。两组比较差异显著(P=0.007)。结论不稳定的呼吸调控可能影响PAP短期治疗疗效。对环路增益和混合性呼吸暂停指数较高的患者,采用单水平自动呼吸机治疗有相对更高的失败率。
OBJECTIVE We hypothesized that unstable ventilatory control（high loop gain,LG） could predict the short-term efficacy of positive airway pressure therapy in patients with obstructive sleep apnea（OSA）.METHODS 42 adult patients with OSA,M/F=39/3, were studied. The stability of the ventilatory control system（LG）was quantified by fitting a simplified mathematical model to the spontaneous ventilatory pattern obtained via polysomnography. LG, pulmonary function test results, and other PSG parameters were analyzed in patients who had post-treatment AHI≥10 events/hr（non-responders） using auto-positive airway pressure therapy. RESULTS The subjects aged（40±8） years,apnea-hypopnea index（AHI）were 68.2[42.9, 81.0]events/hr）. Nine patients（34.6%）were non-responders. Twenty patients（47.6%） had residual AHI5 events/hr. Loop gain and pre-treatment mixed apnea index were higher in the non-responders versus responders（0.74 [0.62, 0.82] vs 0.49[0.37, 0.77],P=0.035） and（11.0[4.3, 22.9] vs 2.0[0.2, 5.3], P=0.004）.In the 26 patients with LG0.6, nine（34.9%） had posttreatment 5 events/hr≤AHI10 events/hr. And all of the non-responders had LG（n=9, 34.9%）. The difference was significant between the LG0.6 and LG0.6 group（P = 0.007）. CONCLUSION Loop gain and mixed apnea index was higher in patients with residual AHI10 events/hr after short-term auto-PAP therapy.Ventilatory control stability evaluation might have predictive value for PAP treatment efficacy in OSA patients.
作者
李彦如
丁秀
郜飞
杨庆文
王小轶
徐文
韩德民
L;DING Xiu;GAO Fei;YANG Qingwen;WANG Xiaoyi;XU Wen;HAN Demin(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Key Laboratory of Otolaryngology Head and Neck Surgery（Capital Medical University）,Ministry of Education,Beijing,100730,China)
出处
《中国耳鼻咽喉头颈外科》
CSCD
2018年第7期375-379,共5页
Chinese Archives of Otolaryngology-Head and Neck Surgery
基金
国家重点研发计划(2017YFC0112500)
首都医科大学附属北京同仁医院科研骨干基金(2017-YJJ-GGL-006)联合资助
