改变睡眠姿势联合吸氧治疗对心力衰竭患者陈-施呼吸的疗效

摘要

Objective To explore the curative effect of changing sleep posture combined oxygen therapy on Cheyne-Stokes respiration(CSR) in patients with heart failure.Methods Fifty patients with stable heart failure who had moderate-severe CSR successively received oxygen therapy alone for one night and changing sleep posture combined oxygen therapy for another night randomly.Their beds were horizontal when patients received oxygen therapy alone(oxygen therapy group) and all patients received nasal catheter oxygen at 3 L/min.Their beds were elevated by 45°when patients received changing sleep posture combined oxygen therapy(posture + oxygen therapy group).Polysomnography was used to monitor the overnight sleep of all patients before and after treatment,and the results were compared.Results Only 36 patients all had non-rapid eye movement(NREM) 1 period(N1),N2,N3 and rapid eye movement(REM) during sleep of 50 patients.Apnea-hypopnea index(AHI),attenuated arousal index(Arol),mean pulse oxygen saturation (SpO2),the lowest SpO2,oxygen desaturation index(ODI),time of N1 + N2/total sleep time [TST,(N1 +N2)/TST] and time of N3/ TST(N3/TST) were significantly different among oxygen therapy group,posture + oxygen therapy group and before treatment (P ＜ 0.05),but lung to finger circulation time (LFCT),time of REM/TST(REM/TST) and TST were not significantly different between the three groups(P ＞ 0.05).AHI and AroI were lower in posture + oxygen therapy group than those in oxygen therapy group(P ＜ 0.05),but mean SpO2,the lowest SpO2,ODI,(N1 + N2)/TST and N3/TST were not significantly different(P ＞ 0.05).Pearson correlation analysis showed that left ventricular ejection fraction were negatively correlated with AHI and LFCT(r =-0.486,-0.601,P ＜ 0.05) in patients with heart failure and CSR.Conclusion Changing sleep posture combined oxygen therapy can reduce the severity of CSR in patients with heart failure more than simple oxygen and has no adverse effects on sleep structure.%目的 探讨改变睡眠姿势联合吸氧治疗对心力衰竭(简称心衰)患者陈-施呼吸(CSR)的疗效.方法 对50例存在中-重度CSR的稳定期心衰患者随机先后进行1晚的单纯吸氧治疗和1晚的改变睡眠姿势联合吸氧治疗,单纯吸氧治疗时(氧疗组)患者的床呈水平位,予鼻导管吸氧(3 L/min);改变睡眠姿势联合吸氧治疗时(姿势+氧疗组)将患者的床头抬高45.,同时予鼻导管吸氧(3L/min).治疗前后采用多导睡眠监测系统监测所有患者的整夜睡眠情况并对其结果进行比较.结果 50例患者中仅36例患者非快速眼动1期(N1)、非快速眼动2期(N2)、非快速眼动3期(N3)和快速眼动期(REM)在睡眠时全部出现.氧疗组、姿势+氧疗组及治疗前呼吸暂停低通气指数(AHI)、微觉醒指数(AroI)、平均脉搏血氧饱和度(SpO2)、最低SpO2、氧减指数(ODI)、(N1+ N2)时间/总睡眠时间[TST,(N1+ N2)/TST]及N3时间/TST(N3/TST)比较,差异均有统计学意义(P＜0.05),而3组间肺-指循环时间(LFCT)、REM时间/TST(REM/TST)及TST比较差异无统计学意义(P＞0.05).姿势+氧疗组AHI、AroI均低于氧疗组,差异有统计学意义(P＜0.05),而氧疗组和姿势+氧疗组平均SpO2、最低SpO2、ODI、(N1+ N2)/TST、N3/TST比较,差异均无统计学意义(P＞0.05).Pearson相关分析结果显示,心衰合并CSR患者的左心室射血分数与AHI、LFCT均呈负相关(r=-0.486,-0.601,P均＜0.05).结论 改变睡眠姿势联合吸氧治疗较单纯吸氧治疗更能减轻心衰患者CSR的严重程度,且对睡眠结构无不利影响.