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持续正压通气联合减重治疗阻塞性睡眠呼吸暂停低通气综合征伴肥胖患者的初步研究
A preliminary study of CPAP ventilator combined with Weight loss in the treatment of obstructive sleep apnea-hypopnea syndrome patients with obesity
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DOI:
作者:
王晶,刘玉昊,李君,韩伟
WANG Jing, LIU Yuhao, LI JUN, HAN Wei
作者单位:
266071 青岛市市立医院东院区呼吸内科(王晶、李君、韩伟),心内科(刘玉昊)
Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao 266071, China
关键词:
阻塞性睡眠呼吸暂停低通气综合征;持续正压通气;减重;肥胖
Obstructive sleep apnea-hypopnea syndrome; CPAP(Continuous Positive Airway Pressure); Weight loss; Obesity
摘要:
目的 探讨持续正压通气(CPAP)联合减重治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴肥胖患者的临床疗效。方法 60例OSAHS伴肥胖患者随机分入CPAP治疗组、减重治疗组和联合治疗组,每组20例,分别予以CPAP、减重和二者联合治疗3个月。观察并比较3组OSAHS伴肥胖患者治疗前后自体变化,如体重、BMI、颈围、腰围等;睡眠状态,如最长呼吸暂停时间(LAT)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)的改善情况;肺功能,如补呼气量(ERV%)、用力肺活量(FVC%)的改善情况。结果 CPAP治疗组患者治疗后的体重显著重于同组治疗前(P<0.05),BMI、颈围、腰围均显著大于同组治疗前(P值均<0.05);减重治疗组和联合治疗组患者治疗后的体重均显著轻于同组治疗前(P值均<0.05),BMI、颈围、腰围均显著小于同组治疗前(P值均<0.05);联合治疗组患者治疗前后的体重差值、BMI差值、颈围差值、腰围差值均显著大于减重治疗组(P值均<0.01)。3组患者治疗后的LAT均显著短于同组治疗前(P值分别<0.01、0.05),AHI均显著低于较同组治疗前(P值均<0.01),LSaO2均显著高于同组治疗前(P值分别<0.01、0.05)。联合治疗组患者治疗前后的LAT差值、AHI差值、LSaO2差值均大于其他两组(P值均<0.01)。CPAP治疗组患者治疗后的ERV%和FVC%均显著小于同组治疗前(P值均<0.01),减重治疗组和联合治疗组患者治疗后的ERV%和FVC%均显著大于同组治疗前(P值均<0.01)。联合治疗组患者前后的ERV%差值和FVC%差值均显著大于减重治疗组(P值均<0.01)。结论 OSAHS伴肥胖患者在接受CPAP治疗的同时,还应该接受在一定范围内的减轻体重的治疗。
Objective To explore treatment effect of the CPAP ventilator and weight loss and combined treatment on obstructive sleep apnea-hypopnea syndrome(OSAHS)patients with obesity. Methods Sixty patients with OSAHS associated with obesity were randomly divided into CPAP treatment group, weight loss treatment group and the combined treatment group. Every group include 20 patients. They respectively were treated with CPAP, weight loss and the combined treatment for 3 months. We observed and compared the changes of themselves(such as weight, BMI, neck circumference and waist circumference), sleep(such as the longest apnea time(LAT), Apnea hypoventilation index(AHI) and the lowest oxygen saturation(LSaO2)) and lung function(such as expiratory reserve volume(ERV%) and forced vital capacity(FVC%)) in three groups of patients before and after treatment. Results The weight after treatment is significantly higher than the weight before treatment in CPAP treatment group(P<0.05). The BMI, neck circumference and waist circumference are all significantly higher than the weight before treatment in the same group(P<0.05). The weight after treatment is significantly lower than the weight before treatment in weight loss treatment group and the combined treatment group(P<0.05). The BMI, neck circumference and waist circumference are all significantly higher than the weight before treatment in the same group(P<0.05). The difference of weight, BMI, neck circumference and waist circumference before and after treatment in the combined treatment group is significantly greater than those in weight loss treatment group(P<0.01). The LAT after treatment is significantly shorter than the LAT before treatment in the three groups(respectively P<0.01,0.05).The AHI after treatment is significantly lower than the AHI before treatment in the same group(P<0.01). The LSaO2 after treatment is significantly higher than the LSaO2 before treatment in the same group(respectively P<0.01,0.05). The difference of LAT,AHI,LSaO2 before and after treatment in the combined treatment group is significantly greater than those in the other two groups(P<0.01). The ERV% and FVC% after treatment are significantly less than those before treatment in CPAP treatment group(P<0.01). The ERV% and FVC% after treatment are significantly greater than those before treatment in weight loss treatment group and the combined treatment group(P<0.01). The difference of ERV% and FVC% before and after treatment in the combined treatment group is significantly greater than those in weight loss reatment group(P<0.01).Conclusions Patients with OSAHS associated with obesity in CPAP treatment at the same time, should also be treated within a certain range of weight loss.
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