摘要
夜间鼻间歇式正压通气(NIPPV)是因神经肌肉或胸壁功能障碍导致呼吸功能不全患者清醒血气恢复正常的有效手段。然而,长期通气对此类患者睡眠时自主呼吸的影响却很少受到关注。本研究的目的是确定长期鼻通气后睡眠中的自主呼吸是否改善。14例有记录的夜间呼吸衰竭患者接受夜间无创通气治疗至少6个月,在没有呼吸支持的情况下进行通宵多导睡眠仪检查。将非快速眼动(NREM)和无夜间通气的快速眼动(REM)睡眠中夜间去饱和的严重程度与最初诊断研究中测量的去饱和程度进行比较。与鼻通气前相比,随访时自发日间血气值(平均+/- SD)显著改善:动脉氧张力(Pa,O2): 7.5 +/- 1.2至10.2 +/- 1.3 kPa (p < 0.005);动脉二氧化碳张力(Pa,CO2) 8.2±1.6 ~ 6.4±0.7 kPa (p < 0.001)。当最大吸气压力(Pl, max)从基线值41 +/- 18增加到65 +/- 26% (p < 0.003)时,吸气肌力量也有显著改善。长期治疗后睡眠自主呼吸明显改善,但仍不正常。在无呼吸支持的NREM睡眠期间,氧饱和度明显低于初始研究的严重程度(动脉氧饱和度(Sa,O2) 88 +/- 4 vs 78 +/- 8%; p < 0.001). Minimum Sa,O2 during REM sleep similarly improved from a mean value of 49 +/- 14% during the diagnostic night to 73 +/- 10% at review follow-up (p < 0.001). In 12 patients, transcutaneous carbon dioxide was measured continuously during sleep on both occasions and demonstrated significantly less CO2 retention during follow-up compared to control studies both in NREM (p < 0.003) and REM sleep states (p < 0.004). Long-term nocturnal ventilation produces improved respiratory drive both asleep and awake and improved arousal responses to abnormal blood gases.