摘要目的 探讨高原地区慢性肺源性心脏病急性加重期(AEHACCP)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的预后危险因素.方法 对66例AEHACCP合并OSAHS患者的颈围(Nc)、体质指数(BMI)、动脉血气、多导睡眠图监测参数与预后的关系进行单因素分析及多因素Logistic回归分析.结果 AEHACCP合并OSAHS患者的Nc≥45 cm、BMI≥28 kg/m2、动脉血氧分压(PaO2)≤40 mm Hg(1 mm Hg=0.133 kPa)、平均肺动脉压(mPAP)≥45 mm Hg、睡眠呼吸暂停低通气指数(AHI)≥40次/h、平均氧饱和度(MSaO2)≤0.70、睡眠SaO2<0.70占睡眠时间百分比(T70)≥50%、夜间基础氧饱和度与最低氧饱和度之差(△SaO2)≥0.20与其预后关系密切.经多因素Logistic回归分析,Nc≥45 cm[比值比(OR)6.781,95%可信区间(CI)1.153～17.502,P=0.007]、BMI≥28 kg/m2(OR 7.562,95%CI 1.012～23.457,P=0.004)、mPAP≥45 mm Hg(oR 6.991,95%CI 1.353～20.155,P=0.003)、AHI≥40次/h(OR 7.258,95%CI 1.526～18.022,P=0.006)、MSaO2≤0.70(OR 6.488,95%CI 1.562～26.878,P=0.008)、T70≥50%(OR5.593,95%CI 1.265～21.589,P=0.008)、ASaO2≥0.20(OR 6.551,95%CI 1.495～18.920,P=0.007)是影响AEHACCP合并OSAHS患者预后的独立危险因素.结论 Nc≥45 cm、BMI≥28 kg/m2、mPAP≥45 mm Hg、AHI≥40次/h、MSaO2≤0.70、T70≥50%、△SaO2≥0.20是导致AEHACCP合并0SAHS患者病死率增加的7个独立因素,在临床上要密切观察,并指导治疗,判断预后,降低病死率.

abstractsObjective To assess the prognostic risk factors in the patients with acute exacerbation of chronic cor pulmonale (AEHACCP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) in high altitude area.Methods The relations between neck circumference (No), body mass index (BMI), arterial blood gases, polysomnography (PSG) parameters and prognosis from 66 patients with AEHACCP and OSAHS (31 survivors, 35 non-survivors) were studied by one variable analysis and multivariable Logistic regression analysis.Results The results of one variable analysis showed that in patients with AEHACCP and OSAHS, Nc≥45 cm, BMI≥28 kg/m2, arterial oxygen partial pressure (PaO2)≤ 40 mm Hg (1 mm Hg=0.133 kPa), mean pulmonary arterial pressure (mPAP)≥45 mm Hg, apnea-hypopnea index(AHI)≥40 times/h, sleep mean arterial oxygen saturation (MSaO2)≤ 0.70, percentage of the duration of SaO2 <0.70 during sleep (T70)≥50 % and difference between basic and minimum SaO2 during sleep (△SaO2)≥0.20 were closely correlated with prognosis.The Logistic regression models showed that Nc≥45 cm [odds ratio (OR)= 6.781, 95% confidence interval (95%CI) = 1.153 - 17.502, P= 0.007], BMI≥28 kg/m2(OR=7.562, 95%CI=1.012 - 23.457, P = 0.004), mPAP≥ 45 mm Hg (OR = 6.991,95%CI=1.353 -20.155, P=0.003), AHI≥40 times/h (OR = 7.258, 95%CI = 1.526 - 18.022, P=0.006), MSaO2≤0.70 (0R=6.488, 95%CI=1.562- 26.878, P=0.008), T70≥50% (OR=5.593, 95%CI=1.265 - 21.589, P=0.008) and △SaO2≥0.20 (OR=6.551, 95%CI=1.495 - 18.920, P=0.007) were independent significant risk factors in prognosis of patients with AEHACCP and OSAHS.Conclusion The patients with AEHACCP and OSAHS, Nc≥45 cm, BMI ≥ 28 kg/m2, mPAP≥ 45 mm Hg, AHI≥40 times/h, MSaO2≤0.70, T70≥50% and ASaO2≥0.20 are risk factors leading to a rise in mortality.It is important to use these paramaters to guide clinical therapy, and to judge the prognosis so as to reduce the mortality of patients with AEHACCP and OSAHS by monitoring the above risk factors in clinical practice.