肺血栓栓塞症合并阻塞性睡眠呼吸暂停低通气综合征患者28例临床特点分析

摘要

目的 调查肺血栓栓塞症(PTE)患者合并OSAHS患者的临床特点,研究合并OSAHS对于PTE患者起病及病情严重程度的影响并比较临床干预的差异.方法 分析2002年1月至2010年12月期间北京安贞医院呼吸科收治的28例合并OSAHS的住院PTE患者的一般情况、吸烟指数、栓塞面积、是否合并高血压、肺动脉高压和下肢深静脉血栓(DVT)等,观察动脉血气分析结果、呼吸暂停低通气指数( AHI)、夜间最低脉搏氧饱和度(SpO2)和所接受的临床干预措施,并与30例不合并OSAHS的PTE患者进行比较.结果 合并OSAHA的住院FT'E患者年龄[(55±11)岁]较不合并OSAHS的PTE患者年轻[(66±11)岁,t=3.230,P＜0.01],体重指数[(30.1±2.8)kg/m2 vs (26.1±3.1) kg/m2,t=-4.161,P＜0.001]和吸烟指数[(19±6)包年vs(8±4)包年,t=- 1.713,P＜0.05]均大于后者；Pa02明显低于未合并OSAHS的PTE患者[(70±8) mm Hg vs (79±6) mm Hg,1 mm Hg=0.133 kPa,t =4.233,P＜0.05]；栓塞累及的肺段数量多于不合并OSAHS组[(8±4)个vs(5±3)个,t=-2.496,P＜0.05].2组均采用抗凝和(或)溶栓治疗,部分合并OSAHS的PTE患者在此基础上应用无创正压通气(CPAP)治疗.结论 合并PTE的住院OSAHS患者一般发病年龄较轻,肺栓塞病情较重,临床上需要采取以抗凝和CPAP为主的综合治疗.%Objective To describe the clinical features of obstructive sleep apnea-hyponea syndrome (OSAHS) in hospitalized pulmonary thromboembolism (PTE) patients,and to explore its impact on the severity of disease and management among patients with PTE.Methods Demographic and clinical characteristics of 28 PTE patients complicated with OSAHS admitted to this hospital from January 2002 to December 2010 were analyzed.A total of 30 PTE patients without OSAHS served as a control group.Results PTE patients with OSAHS had a significantly lower age of onset of disease [ (55 + 11 ) yr vs ( 66 + 11 ) yr,t =3.230,P ＜ 0.01 ],an increased body mass index ( BMI ) [ ( 30.1 ± 2.8 ) kg/m2 vs ( 26.1 ± 3.1 )kg/m2,t =-4.161,P ＜0.001 ] and a higher smoking index [ ( 19 ±6) packs/yr vs (8 ±4) packs/yr,t=-1.713,P＜0.05] when compared with PTE patients without OSAHS.PaO2 [(70 ±8) mm Hg vs (79±6) mm Hg,1 mm Hg=0.133 kPa,t =4.233,P＜O.05] and involved lung segments [(8 ±4) vs ( 5 + 3),t =- 2.496,P ＜ 0.05 ] in PTE patients with OSAHS were more severe than those in PTE patients without OSAHS.All patients received anticoagulation and/or thrombolysis treatment,and continuous positive airway pressure (CPAP) ventilation was used in some PTE patients with OSAHS. Conclusion PTE patients with OSAHS had a significantly earlier age of onset of disease and more severe conditions than PTE patients without OSAHS.Treatments including anticoagulation and CPAP should be used in these patients.