Trial of BiPAP during Sleep in Chronic Respiratory Failure with hypercapnic

睡眠期间 BiPAP 在伴有高碳酸血症的慢性呼吸衰竭中的试验

• 批准号: 07670677
• 负责人: ABE Tadashi
• 金额: $ 1.47万
• 依托单位: KITASATO UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1995
• 资助国家: 日本
• 起止时间: 1995 至 1996
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07670677/
• 关键词: Chronic respiratory failuve; Pulse oxymeter; BiPAP; Hypoxia; Oxygen desaturation; 呼吸不全; パルスオキシメーター

Purpose : Some patients with chronic respiratory failure, especially patients with hypercapnia, show severe nocturnal oxygen desaturation. The oxygen desaturation during sleep aggravate the general condition of the patients. The main reason of the oxygen desaturation is believed to be the hypoventilation during sleep. Meanwhile, pressure support ventilator has been ameliorated and bilevel positive airway pressure (BiPAP) system, by which we can expect better tolerance, has become available. We, therefore, tried to elucidate the pathophysiology of nocturnal oxygen desaturation, way of setting of BiPAP and optimal setting of pressures for BiPAP,in order to apply BiPAP properly for patients of chronic respiratory failure with nocturnal oxygen desaturation.Methods : We measured oxygen desaturation during sleep using pulse oxymeter and recorded continuously using a notebook computer in 40 patients with chronic respiatory failure. In 20 patients, measurements were repeated for more than a mo … More nth and the results were compared with the various parameters showing general conditions. Some of the patients showing nocturnal hypoxia were examined using polysomnograph and capnograph in addition to pulse oxymeter. Relations of the sleep stage to the nocturnal oxygen desaturation, ventilation, or end-tidal CO2 were analyzed. BiPAP was applied during sleep to some of the patients with nocturnal oxygen desaturation.Results : Many patients of chronic respiratory failure with daytime PaO2 over 60 torr showed nocturnal oxygen desaturation and some of them were very severe desaturation. Most of the patients showing severe nocturnal desaturation had history of repeated admission for acute exacerbation. Nocturnal oxygen desaturation was worse in REM stage than in non-Rem stage. BiPAP satisfactory prevented nocturnal oxygen desaturation even in REM stage. Repeated trials were necessary to obtain optimal pressures for BiPAP.Conclusion : Prevention of nocturnal oxygen desaturation is important for the patients of chronic respiratory failure and BiPAP satisfactory prevents the nocturnal oxygen desaturation. Less

目的：一些慢性呼吸衰竭患者，特别是高碳酸血症患者，表现出严重的夜间氧饱和度。睡眠时的氧饱和度降低会加重患者的全身状况。氧饱和度降低的主要原因被认为是睡眠时的低通气。与此同时，压力支持呼吸机得到了改进，双水平气道正压通气（BiPAP）系统得到了应用，我们可以期望更好的耐受性。因此，我们试图阐明夜间氧饱和度降低的病理生理、BiPAP的设置方式以及BiPAP的最佳压力设置，以便在夜间氧饱和度降低的慢性呼吸衰竭患者中正确应用BiPAP。方法：对40例慢性呼吸衰竭患者，采用脉搏血氧计测定睡眠时血氧饱和度，并用笔记本电脑连续记录。在20例患者中，测量重复了一个多月，并将结果与显示一般情况的各种参数进行了比较。部分出现夜间缺氧的患者除脉搏血氧计外，还采用多导睡眠仪和摄氧量仪检查。分析睡眠阶段与夜间氧饱和度、通气量、潮末CO2的关系。一些夜间氧饱和度过低的患者在睡眠期间应用BiPAP。结果：许多慢性呼吸衰竭患者白天PaO2大于60torr时均表现为夜间氧饱和度过低，部分患者表现为非常严重的氧饱和度过低。出现严重夜间去血饱和度的患者多有多次急性加重住院史。REM期夜间血氧饱和度较非REM期差。满意的BiPAP防止夜间氧饱和度下降，即使在REM阶段。为了获得BiPAP的最佳压力，需要反复试验。结论：预防夜间氧去饱和对慢性呼吸衰竭患者有重要意义，满意的BiPAP可预防夜间氧去饱和。少