【摘要】 目的探讨引起阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者清醒时血气分析变化的相关因素。方法选取成人OSAHS患者212例,将年龄、体质量指数(BMI)、睡眠参数、肾功能、肺功能与血气分析指标包括pH值、氧分压(PaO2)、二氧化碳分压(PaCO2)行相关性分析,找出影响pH值、PaO2、PaCO2的指标,并行多元线性逐步回归分析。结果OSAHS患者的pH值与年龄、睡眠呼吸暂停指数(AHI)、夜间最低血氧饱和度(LaSO2)、夜间平均血氧饱和度(MSaO2)、氧饱和度低于90%的时间占监测时间的百分比(Ts90%)、氧减指数(ODI)及弥散功能(DLCO/VA%)呈显著相关(P均<0.05);PaO2与BMI、AHI、LaSO2、MSaO2、Ts90%、ODI呈显著相关(P均<0.05);PaCO2与年龄、AHI、呼吸暂停低通气时间指数(AHTI)、LaSO2、MSaO2、Ts90%、ODI、DLCO/VA%呈显著相关(P均<0.01)。分别以pH值、PaO2、PaCO2为因变量行多元逐步回归分析,结果显示,年龄、LaSO2是pH值的预测因子(β=0.428,P=0.000;β=0.289,P=0.002),LaSO2及BMI是PaO2的预测因子(β=0.269,P=0.007;β=-0.261,P=0.009),LaSO2、DLCO/VA%是PaCO2的预测因子(β=-0.392,P=0.000;β=0.213,P=0.025)。结论 OSAHS患者白天血气分析中,酸碱平衡、白天低氧血症分别与年龄、肥胖相关,肺弥散功能对高碳酸血症有一定影响作用,而睡眠时夜间最低血氧是导致OSAHS患者血气分析紊乱的重要因素。更多还原

【Abstract】 Objective To investigate the corrected factors of blood gas analysis in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods 212 cases of patients who underwent standard polysomnography and were diagnosed OSAHS were included. Age,BMI,polysomnography parameters,renal function,lung function and blood gas analysis were recorded. The correlation between blood gas analysis[pH,partial pressure of oxygen(PaO2),carbon dioxide partial pressure(PaCO2)]and clinical,polysomnographic,and metabolic parameters were evaluated by the Pearson’s correlation test.The multivariate linear regression model was performed to examine determinants of blood gas analysis(pH,PaO2,PaCO2). Results There were significant correlations between pH and AHI,LaSO2,MSaO2,Ts90%,ODI,DLCO/VA%. Pearson’s correlation also revealed a significant association between PaO2 and BMI,AHI,LaSO2,MSaO2,Ts90%and ODI. Additionally,PaCO2 also revealed a significant association between AHI,AHTI,LaSO2,MSaO2,Ts90%,ODI and DLCO/VA%. When using blood gas analysis(pH,PaO2,PaCO2)as a dependent variable,age and LaSO2 significantly predicted pH after adjustment for confounders(β=0.428,P=0.000;β=0.289,P=0.002,respectively),LaSO2 and BMI significantly predicted PaO2(β=0.269,P=0.007;β=-0.261,P=0.009),LaSO2 and DLCO/VA% significantly predicted PaCO2(β=-0.392,P=0.000;β=0.213,P=0.025). Conclusion Acidbase balance and daytime hypoxemia are related to age and obesity,respectively,and pulmonary diffusion has certain influenceon hypercapnia. In addition,nocturnal hypoxemia is an importantdisorder leading to the change in daytime blood gas analysis in patients with OSAHS.更多还原