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清醒时氧饱和度正常的COPD患者非快速动眼时相对夜间低氧血症脑损伤的影响
Effect of hypoxemia in non-rapid eye movement period sleep on brain injury in COPD patients

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DOI:
作者:
王才木，陈启江，崔巍，张根生
Caimu Wang, Qijiang Chen, Wei Cui, Gensheng Zhang
作者单位:
浙江大学附属第二医院重症医学科(王才木为在职硕士研究生、崔巍、张根生)； 宁海县第一医院重症医学科（王才木、陈启江）
Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine. Department of Critical Care Medicine, Ninghai first hospital
关键词:
慢性阻塞性肺疾病；非快速动眼时相；低氧血症；脑损伤；S100B
chronic obstructive pulmonary disease; non-rapid eye movement phase; hypoxemia; brain injury; S100B
摘要:
【摘要】 目的：慢性阻塞性肺疾病（COPD）患者非快速动眼睡眠（NREM）时相存在的低氧血症以及对脑损伤的影响鲜有报道，本研究评估清醒时氧饱和度正常的COPD患者非快速动眼相睡眠（NREM）出现低氧血症的发生率以及这种氧饱和度降低对脑损伤的影响。方法：分析我院2014年1月至2016年1月符清醒不吸氧时氧饱和度正常的64例COPD病例，根据夜间氧饱和情况（不吸氧时）分为正常组、NREM低氧组、REM低氧组和混合低氧组，以血清S100B标记物评估脑损伤；记录和分析这些患者的一般资料、夜间氧合情况、血清S100B水平及其与低氧血症的关系。结果：所有64例患者中，男性39例，年龄为65.9±9.0岁，夜间低氧血症有41例（64.06%）。在低氧血症COPD患者中， 48.78%发生在REM时相（20/41），31.70%发生在NREM时相（13/41），而19.51%在REM和NREM两时相(混合相)均发生低氧血症。一般资料如性别、年龄、BMI、并发症及肺功能检测等参数在4组之间均无统计学意义（P﹥0.05）。正常组患者总睡眠时间、PaO2、SaO2均明显高于其他3组（P﹤0.05），SpO2 ＜90％占总睡眠时间的百分比明显低于其他3组（P﹤0.001），并且血清S100B在正常组（2909.02±257.90pg/ml）显著低于其他3组[分别为NREM低氧组（3552.74±326.10 pg/ml）、REM低氧组（3449.00±295.68pg/ml）和混合低氧组（3439.21±357.47pg/ml）]（P﹤0.05）。 各项指标在REM时相、NREM时相、混合时相这3组之间无统计学差异（P﹥0.05）。 此外， 夜间低氧并不影响PaCO2、AHI以及觉醒指数（P﹥0.05）。S100B与PaO2和SaO2均呈负相关性（分别为r=﹣0.472，r=﹣0.358，P均﹤0.001），而与夜间睡眠SpO2﹤90％所占时间为正相关（r=0.70，P﹤0.001）。结论： 清醒时氧饱和度正常的COPD患者夜间低氧血症超过30%在非快速眼动相 ，其参与了COPD患者的低氧性脑损伤。 同时，血清S100B 可以作为评估COPD患者低氧性脑损伤的有价值标记物。
【Abstract】 Objective: The presence of hypoxemia in patients with chronic obstructive pulmonary disease (COPD) with non-rapid eye movement (NREM) sleep and its effect on brain injury are rarely reported, The aim of this study was to evaluate the incidence of hypoxemia in NREM sleep in COPD patients with a normal oxygen saturation at daytime and its effect on brain injury. Methods: A total of 64 COPD cases were analyzed retrospectively from January 2014 to January 2016. According to oxygen saturation at night without oxygen therapy, the patients were divided into normal group, NREM hypoxia group, REM hypoxia group and mixed l hypoxia group, and the marker of serum S100B was used to assess the brain damage. The general data, nighttime oxygenation status, serum S100B level and its relationship to hypoxemia were recorded and analyzed. Results: A total of 64 patients was recruited including 39 men, with a mean age of 65.9±9.0 years and a nocturnal hypoxemia rate of 64.06% (41/64). Among the patients with nocturnal hypoxemia, 48.78% (20/41) was occurred in REM phase, 31.70% in NREM phase and 19.51% in the mixed phase. There were no significant differences in gender, age, BMI, complications and pulmonary function among the four groups (P> 0.05). The percentage of total sleep time, PaO2 and SaO2 in the normal group were significantly higher than those in the other three groups (P <0.05), and the percentage of SpO2 <90% in the total sleep time was significantly lower than that in the other three groups (P <0.05).Serum S100B was significantly lower in the normal group (2909.02 ± 257.90pg/ml) than those in the other three groups [(3552.74 ± 326.10pg / ml), (3449.00 ± 295.68pg / ml) and (3439.21 ± 357.47pg / ml) in NREM hypoxia group, REM hypoxia group and mixed hypoxia group respectively, all P <0.05],while there was no significant differences among the three hypoxia groups (P> 0.05). In addition, hypothermia at night had no effect on the parameters of PaCO2, AHI, and arousal index. The S100B level has significantly negative correlation with PaO2 (r = -0.472, P <0.001) or SaO2 (r = -0.358, P <0.001), but positively correlated with the time of nighttime sleep SpO2 <90% (R = 0.70, P <0.001).Conclusion: More than 30% of COPD patients with a normal oxygen saturation at daytime suffer nocturnal hypoxia in non-rapid eye movement phase, which also ascribes to the hypoxia -associated brain injury; In addition, the serum S100B might be used as a valuable marker of hypoxia-induced brain injury in patients with COPD.

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