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目的了解单纯慢性阻塞性肺病(COPD)与重叠综合征(Os)患者睡眠事件的差异,评价短期口服茶碱联合口腔矫治器治疗重叠综合征的疗效。方法随机选择40例住院稳定期慢性阻塞性肺病患者,并应用多导睡眠监护仪进行监测,并通过自身前后对照的方法观察口服茶碱联合口腔矫治器对重叠综合征患者的治疗效果,据监测结果,将其分为两组,单纯COPD组(n=27),重叠综合征组(n=13)。对11例重叠综合征患者给予口服茶碱联合口腔矫治器治疗,共7~10 d,茶碱平均剂量为6.3 mg/kg。结果重叠综合征的睡眠呼吸紊乱指数(AHI)为(38±9)次/h,阻塞性AHI为(16±8)次/h,中枢性AHI为(22±10)次/h。睡眠中最低血氧饱和度为76±6,均较单纯COPD严重。11例患者经联合治疗后血清平均茶碱浓度为(10.30±2.1)mg/ml,AHI明显下降(P<0.01),中枢性AHI减少(P<0.05),阻塞性AHI减少(P<0.05)。血氧饱和度低于90%的时间占总睡眠时间的百分比下降(P<0.01)。结论口服茶碱联合口腔矫治器治疗重叠综合征方便、无创、无风险,患者依从性好,且两者治疗效果有互补之功效。
Objective To investigate the difference of sleep events between patients with chronic obstructive pulmonary disease (COPD) and overlapping syndrome (Os) and to evaluate the efficacy of short-term oral theophylline combined with oral appliance in the treatment of overlapping syndrome. Methods Forty patients with stable chronic obstructive pulmonary disease (COPD) were enrolled in the study. They were monitored by polysomnography, and the therapeutic effect of oral theophylline plus oral appliance on patients with overlapping syndrome was observed by self-control method. The results were divided into two groups, simple COPD group (n = 27), overlap syndrome group (n = 13). Eleven patients with overlapping syndrome were treated with oral theophylline combined with oral appliance, a total of 7 ~ 10 d, theophylline average dose of 6.3 mg / kg. Results The overlap syndrome had a sleep disturbance index (AHI) of (38 ± 9) times / h, obstructive AHI of (16 ± 8) times / h and central AHI of (22 ± 10) times / h. The lowest oxygen saturation in sleep was 76 ± 6, which was more serious than simple COPD. Serum average theophylline concentration in the 11 patients was (10.30 ± 2.1) mg / ml, AHI was significantly decreased (P <0.01), central AHI was decreased (P <0.05), obstructive AHI was decreased . The percentage of total oxygen saturation less than 90% of the total sleep time decreased (P <0.01). Conclusion oral theophylline combined with oral appliance for the treatment of overlapping syndrome is convenient, noninvasive, no risk, patient compliance is good, and the therapeutic effect of the two have complementary effects.