全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
-  2017 

预出院慢性阻塞性肺疾病患者夜间低氧血症临床筛查及相关因素分析

DOI: doi:10.7507/1671-6205.201710014

Keywords: 慢性阻塞性肺疾病, 夜间低氧血症, 临床筛查, 危险因素

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的 调查了解计划出院的慢性阻塞性肺疾病(慢阻肺)患者中不同原因所致单纯性夜间低氧血症的罹患率及相关危险因素,以便识别风险患者进行管理。 方法 从我院呼吸内科 2017 年 1 月至 6 月计划出院的 431 例慢阻肺患者中筛选日间氧饱和度≥90% 且符合纳入排除标准的患者。于出院日前两晚采用可穿戴便携式脉氧仪监测其整晚氧饱和度、脉搏、手动等数据,记录患者次日晨间临床症状、日间血气分析、肺功能、Epworth 嗜睡评分(Epworth Sleepiness Score,ESS)、匹兹堡睡眠质量问卷(Pittsburgh Sleep Quality Index,PSQI)结果,将无夜间低氧血症、单纯性夜间低氧血症患者的以上数据进行对比分析。根据血氧曲线波形,将存在单纯性夜间低氧血症患者分为考虑慢阻肺-睡眠呼吸暂停低通气重叠综合征(overlap syndrome,OS)的患者与非 OS 夜间缺氧患者的以上指标进行对比。 结果 共筛选出 106 例无日间缺氧的预出院慢阻肺患者,其中 44 例(41.5%)患者存在夜间低氧血症。夜间低氧的慢阻肺患者氧饱和度[(91.8±1.1)% 比(94.4±1.5)%,P<0.05]低于无夜间缺氧者,其中疑诊 OS 的患者较无夜间缺氧患者急性加重频率[(2.1±0.6)次/年比(1.4±0.4)次/年]、ESS 评分[(10.5±2.7)分比(5.1±2.5)分]、PSQI[(12.8±4.4)分比(7.4±3.1)分]更高(P<0.05)。 结论 在日间氧饱和度大于 90% 的预出院慢阻肺中,仍有约 41.5% 的患者存在单纯性夜间低氧血症。日间氧饱和度较低、存在日间嗜睡的患者更可能存在夜间低氧血症,OS 患者有更高的年急性加重风险及嗜睡程度。应重视预出院慢阻肺患者夜间缺氧的筛查

References

[1]  1. Croxton TL, Bailey WC. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report. Am J Respir Crit Care Med, 2006, 174(4): 373-378.
[2]  2. Lewis CA, Fergusson W, Eaton T, et al. Isolated nocturnal desaturation in COPD: prevalence and impact on quality of life and sleep. Thorax, 2009, 64(2): 133-138.
[3]  3. Chaouat A, Weitzenblum E, Kessler R, et al. Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia. European Respiratory Journal, 1997, 10(8): 1730-1735.
[4]  4. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management and prevention of Chronic Obstructive Pulmonary Disease. (2017 REPORT). Available at: http://www.goldcopd.org.
[5]  5. American Thoracic Society and European Respiratory Society. Standards for the diagnosis and management of patients with COPD. Available at: http://dev.ersnet.org/275-guidelines.htm.
[6]  6. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版)编写组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(基层版). 中国呼吸与危重监护杂志, 2015, 14(4): 398-405.
[7]  7. Lacasse Y, Sériès F, Vujovic-Zotovic N, et al. Evaluating nocturnal oxygen desaturation in COPD--revised. Respir Med, 2011, 105(9): 1331-1337.
[8]  8. 张凤蕊, 平芬, 韩书芝, 等. 老年慢性阻塞性肺疾病患者夜间经皮二氧化碳分压、氧分压及血氧饱和度的变化. 中国老年病学杂志, 2014, 35(20): 5849-5851.
[9]  9. 王一佳, 陶连琴, 时国朝, 等. 慢性阻塞性肺疾病无长期氧疗指征患者夜间低氧血症的日间相关因素分析. 中国呼吸与危重监护杂志, 2012, 11(4): 317-321.
[10]  10. Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest, 2015, 147(1): 266-274.
[11]  11. Jen R, Li YR, Owens RL, et al. Sleep in chronic obstructive pulmonary disease: evidence gaps and challenges. Can Respir J, 2016, 2016: 7947198.
[12]  12. Fletcher EC, Luckett RA, Goodnight-White S, et al. A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 mm Hg. Am Rev Respir Dis, 1992, 145(5): 1070-1076.
[13]  13. Cranston JM, Crockett AJ, Moss JR, et al. Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2005, 19(4): CD001744.
[14]  14. Long-Term Oxygen Treatment Trial Research Group, Albert RK, Au DH, et al. A randomized trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med, 2016, 375(7): 1617-1627.
[15]  15. Lacasse Y, Bernard S, Sériès F, et al. Multi-center, randomized, placebo-controlled trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease: a study protocol for the INOX trial. BMC Pulm Med, 2017, 17(1): 8.
[16]  16. 陈培锋, 和平. 慢性阻塞性肺疾病夜间低氧血症相关预测因素的临床研究. 中国现代医生, 2014, 52(8): 15-18.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133