CPAP和Auto-CPAP治疗重度OSAHS患者的临床疗效比较

doi:10.3969/j.issn.1006-7795.2018.01.021

摘要/Abstract

摘要： 目的探讨持续气道正压通气呼吸机（continuous positive airway pressure，CPAP）与自动调节持续气道正压通气呼吸机（Auto-CPAP）治疗重度阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）患者的治疗效果和依从性，及治疗前后肺功能变化情况。方法通过多导睡眠图（polysomnography，PSG）选取重度OSAHS患者60例，PSG正常对照组56例，均行肺功能检查（pulmonary function test，PFT）。将重度OSAHS患者采用随机数字表分为CPAP组和Auto-CPAP组各30例，分别接受CPAP和Auto-CPAP治疗，观察治疗前和治疗后第1个月、第3个月、第6个月的PSG参数、呼吸机治疗所需压力、平均每晚呼吸机使用时间、Epworth嗜睡量表评分（Epworth Sleepiness Scale，ESS）及肺功能指标变化。结果（1）重度OSAHS患者组与正常对照组用力肺活量（forced vital capacity，FVC）、1秒用力呼出容积（forced expiratory volume in one second，FEV1）、1秒用力呼出容积实测值与预计值比值（FEV1%）、FEV1/FVC、肺总量（total lung capacity，TLC）实测值与预计值比值（实测值与预计值比值）、一氧化碳弥散量（carbon monoxide diffusing capacity，DLCO）实测值与预计值比值、气道总阻力（airway resistance 5，R5）实测值与预计值比值差异无统计学意义（P>0.05），闭合总量（closing capacity，CC）/功能残气量（functional residual capacity，FRC）%（P=0.038）、50%最大呼气流速（peak expiratory flow，PEF50）实测值与预计值比值（P=0.041）、最大呼气中段流速（maximum midexpiratory flow，MMEF）实测值与预计值比值（P=0.037）差异有统计学意义；（2）治疗后第1个月、第3个月、第6个月，CPAP组和Auto-CPAP组呼吸暂停低通气指数（apnea-hypopnea index，AHI）、夜间平均血氧饱和度（nighttime mean pulse oxygen saturation，M SaO₂）、夜间最低血氧饱和度（nighttime the lowest pulse oxygen saturation，L SaO₂）、睡眠潜伏期（sleep latency，SL）、睡眠效率（sleep efficiency，SE）、FVC、FEV1、FEV1%、FEV1/FVC、TLC实测值与预计值比值、DLCO实测值与预计值比值、R5实测值与预计值比值、CC/FRC%、PEF50实测值与预计值比值、MMEF实测值与预计值比值、ESS指标比较，差异均无统计学意义（P>0.05），Auto-CPAP组觉醒次数（wake after sleep onset，WASO），Ⅰ期+Ⅱ期、Ⅲ期+Ⅳ期及快速动眼（rapid eye movement，REM）期睡眠各占总睡眠时间（total sleep time，TST）的比例、呼吸机治疗所需压力、平均每晚呼吸机使用时间与CPAP组比较，差异有统计学意义（P<0.05）；两组第1个月、第3个月、第6个月的AHI、WASO、Ⅰ期+Ⅱ期比例、ESS指标均较治疗前降低，差异有统计学意义（P<0.05），M SaO₂、L SaO₂、Ⅲ期+Ⅳ期比例、REM比例指标均较治疗前升高，差异有统计学意义（P<0.05），SL和SE指标较治疗前升高，差异无统计学意义（P>0.05）；两组第1个月、第3个月、第6个月的肺功能指标FVC、FEV1、FEV1%、FEV1/FVC、TLC实测值与预计值比值、DLCO实测值与预计值比值、R5实测值与预计值比值、CC/FRC%、PEF50实测值与预计值比值、MMEF实测值与预计值比值较治疗前，差异无统计学意义（P>0.05）。所有接受无创呼吸机治疗病例均无明显不良反应。结论重度OSAHS患者早期肺功能受损病变主要发生在小气道且该病变呈不可逆趋势。CPAP和Auto-CPAP对于重度OSAHS患者临床治疗效果相当，但Auto-CPAP对患者睡眠结构改善更佳且依从性更好。

关键词: 阻塞性睡眠呼吸暂停低通气综合征, 持续气道正压通气, 自动调节持续气道正压通气, 多导睡眠图, 肺功能

Abstract: Objective To explore the efficacies and compliances during the treatment of continuous positive airway pressure (CPAP) or auto-continuous positive airway pressure (Auto-CPAP) in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods A total of 116 individuals were enrolled in this study, of which, 60 patients with severe OSAHS diagnosed by the whole night polysomnography (PSG) were randomly divided into CPAP group and Auto-CPAP group(n=30,each). And 56 persons with normal PSG were selected as controls. Both groups were given a pulmonary function test(PFT). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1%, FEV1/FVC, ratio of total lung capacity(TLC) measured value to predicted value, closing capacity (CC)/functional residual capacity (FRC%), ratios of peak expiratory flow (PEF50) measured value to predicted value[PEF50, maximum midexpiratory flow (MMEF), carbon monoxide diffusing capacity(DLCO), airway resistance 5 (R5)] were obtained. Differences in those indexes between two groups were compared. With a computer-assistant diagnostic system, PSG parameter changes in CPAP group and Auto-CPAP group were monitored at 1 month,3 months,6 months. The effect of treatment were evaluated by comparison of sleep latency (SL), sleep efficiency (SE), the number of wake after sleep onset (WASO), time of Ⅰ+Ⅱ over TST, time of Ⅲ+Ⅳ and rapid eye movement (REM) over total sleep time (TST), apnea-hypopnea index (AHI), nighttime mean pulse oxygen saturation (M SaO₂) and nighttime the lowest pulse oxygen saturation (L SaO₂), as well as the mean effective pressure required for ventilation treatment, the ventilator average time nightly, Epworth Sleepiness Scale (ESS), and the PFT parameter changes.Results The differences in FVC, FEV1, FEV1%, FEV1/FVC, ratios of measured value to predicted value(TLC, DLCO, R5) were not statistically significant. The differences in CC/FRC% (P=0.038), ratio of PEF50 measured value to predicted value(P=0.041, ratio of MMEF measured value to predicted value(P=0.037) were statistically significant. At the 1 month,3 months,6 months of treatment, differences in AHI, M SaO₂, L SaO₂, SL, SE, FVC, FEV1, FEV1%, FEV1/FVC,ratios of measured value to predicted value (TLC, PEF50, MMEF, DLCO, R5),CC/FRC% and ESS were not significant differences between CPAP group and Auto-CPAP group(P>0.05 for all of above). The number of WASO, time of Ⅰ+Ⅱ over total sleep time and the effective pressure required for ventilation treatment in Auto-CPAP group were less than those in CPAP group, while the time of Ⅲ+Ⅳ and REM over total sleep time and the ventilator average time nightly in Auto-CPAP group were more than those in CPAP group(P<0.05). Parameters such as AHI, WASO, time of Ⅰ+Ⅱ over total sleep time and ESS at the 1 month, 3 months, 6 months were all lower than those before therapy, while M SaO₂, L SaO₂, time of Ⅲ+Ⅳ and REM over total sleep time were all higher than those before therapy in these two groups(P<0.05),SL and SE were slightly higher than those before treatment, but there were no significant difference(P>0.05). PFT parameters such as FVC,FEV1, FEV1%, FEV1/FVC, ratios of measured value to predicted value(TLC, PEF50, MMEF, DLCO, R5),CC/FRC% at 1 month, 3 months, 6 months showed no significant difference to those before therapy in these two groups(P>0.05). No adverse events were reported during this study.Conclusion Early pulmonary function damage in patients with severe OSAHS is mainly irreversible small airway disease. CPAP and Auto-CPAP are similar in efficacy and safety for OSAHS treatment. Patients under Auto-CPAP treatment showed a better compliance and would benefit more for sleep structure.

Key words: obstructive sleep apnea-hypopnea syndrome, continuous positive airway pressure (CPAD), Auto-CPAP, Z polysomnography, pulmonary function test

中图分类号:

R605.9

岳英明, 孟琨, 邱小建. CPAP和Auto-CPAP治疗重度OSAHS患者的临床疗效比较[J]. 首都医科大学学报, 2018, 39(1): 120-127.

Yue Yingming, Meng Kun, Qiu Xiaojian. Comparison on clinical efficacy of CPAP and Auto-CPAP in patients with severe OSAHS[J]. Journal of Capital Medical University, 2018, 39(1): 120-127.

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