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目的:观察常规加双水平正压通气治疗慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)即重叠综合征(OS)的效果。方法:选择OS 46例,随机分为常规治疗组(常规组)和双水平气道正压通气组(BiPAP组)各23例,另选择单纯COPD23例为对照组。对照组和常规组均给予常规药物治疗及低流量氧疗;BiPAP组在常规治疗基础上加用BiPAP治疗。比较3组夜间最低脉氧饱和度(LSaO_2)、最长呼吸暂停时间(LAT)、睡眠呼吸暂停低通气指数(AHI)、第1秒用力呼气量(FEV1)、第1秒用力呼气量占用力肺活量百分比(FEV1/FVC)、每分钟最大通气量(MVV)及动脉血气pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)等指标变化。结果:治疗前,常规组和BiPAP组的LSaO_2、FEV1、FEV1/FVC、pH值和PaO_2水平显著或非常显著低于对照组(P<0.05,P<0.01);LAT、AHI、PaCO2水平非常显著高于对照组(P<0.01);MVV水平差异不显著(P>0.05)。治疗后,常规组和BiPAP组LSaO2、FEV1、FEV1/FVC、pH值和PaO2水平均显著或非常显著升高(P<0.05,P<0.01),且BiPAP组升高幅度显著或非常显著大于常规组(P<0.05,P<0.01);LAT、AHI、PaCO_2水平均显著或非常显著降低(P<0.05,P<0.01),且BiPAP组的降低幅度显著或非常显著大于常规组(P<0.05,P<0.01)。结论:OS患者夜间与睡眠有关的低氧血症比单纯COPD患者更显著,肺功能受损更加严重;常规加BiPAP治疗OS患者效果优于常规治疗。
Objective: To observe the effect of conventional plus bipolar positive pressure ventilation on patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), ie, overlap syndrome (OS), in patients with chronic obstructive pulmonary disease (COPD). Methods: Forty-six OS patients were randomly divided into routine treatment group (23 cases) and biphasic positive airway pressure group (23 cases). Another 23 cases of COPD were selected as control group. The control group and conventional group were given conventional drug therapy and low flow oxygen therapy; BiPAP group based on conventional therapy plus BiPAP treatment. The three groups of nighttime minimum oxygen saturation (LSaO_2), longest apnea time (LAT), sleep apnea hypopnea index (AHI), forced expiratory volume in 1 second (FEV1), forced expiratory volume in 1 second (FEV1 / FVC), maximal ventilation per minute (MVV) and arterial blood gas pH, arterial partial pressure of oxygen (PaO_2), arterial partial pressure of carbon dioxide (PaCO_2) and other indicators. Results: Before treatment, the level of LSaO_2, FEV1, FEV1 / FVC, PaO_2 in the normal group and BiPAP group were significantly or very significantly lower than those in the control group (P <0.05, P <0.01) (P <0.01). There was no significant difference in MVV between the two groups (P> 0.05). After treatment, the levels of LSaO2, FEV1, FEV1 / FVC, pH and PaO2 in both the normal group and the BiPAP group were significantly or very significantly increased (P <0.05, P <0.01), and the magnitude of increase in the BiPAP group was significantly or significantly higher than that of the conventional (P <0.05, P <0.01). The levels of LAT, AHI and PaCO_2 were significantly or very significantly decreased (P <0.05, P <0.01), and the decrease in BiPAP group was significantly or very significantly greater than that in the conventional group , P <0.01). CONCLUSIONS: Sleep-related hypoxemia is more significant in patients with OS than in patients with COPD alone, and the lung function is more impaired. The conventional treatment with BiPAP is superior to conventional therapy in patients with OS.