Study On Treatment Of Respiratory Central Reactivity And Noninvasive Mechanical Ventilation In Patients With Sleep Dyspnea Combined With COPD

Objectives: To investigate the difference of respiratory central reactivity in patients with chronic obstructive pulmonary disease（COPD）combined with sleep apnea,and to study the need for non-invasive mechanical ventilation（Bi-PAP model）treatment and formulate the correct clinical treatment strategy.Methods: From November 2017 to June 2018,COPD patients who met the conditions of outpatient or inpatient system in our hospital were selected.The patients with sleep apnea hypopnea index（AHI）≥ 5 times / hour were selected by polysomnography.It was divided into COPD complicated with sleep dyspnea group,that is,overlap syndrome（OS）group.Patients with similar BMI and lung function severity and AHI<5 times/h were selected from OS group.Two groups of patients were examined for daytime arterial blood gas analysis,that is,blood gas analysis before the test,spontaneous hyperventilation test,and arterial blood gas analysis again after the test.The changes of arterial partial pressure of oxygen（Pa O₂）and partial pressure of carbon dioxide（Pa CO₂）before and after the test were compared,and the difference of arterial blood gas Pa O₂,Pa CO₂ before and after the test was obtained,which was expressed by Pa O₂（post-test）and Pa CO₂（pre-test-post-test）.The results were statistically analyzed by independent sample T test to indirectly evaluate the characteristics of respiratory center regulation mechanism in patients with overlapping syndrome.（2）OS patients were treated with noninvasive ventilation for 2 weeks.The changes of Pa O₂,Pa CO₂ before and after treatment were compared.Results the clinical strategy of noninvasive ventilation on patients with overlapping syndrome was discussed by using matched sample T test for statistical analysis.Results: Compared with COPD group,△PaO₂ in OS group was 4.3 ±2.3m Hg,and△Pa O₂ in COPD group was 7.6 ±3.5 mm Hg,P < 0.05.There was significant difference in the hypoxic response of respiratory center between the two groups.Compared withCOPD group,△Pa CO₂ in OS group was 5.9 ±3.2 mm Hg,and △Pa CO₂ in COPD group was 7.4 ±4.0 mm Hg,P > 0.05.There was no significant difference in hypercapnia response between the two groups.Before and after treatment,the changes of Pa O₂ and Pa CO₂ in OS patients were compared.For OS patients,Pa O₂ after treatment minus Pa O₂ before treatment,T was 3.365,P < 0.05,and there was a statistical difference in the increase of Pa O₂ before and after treatment.Pa CO₂ After treatment minus Pa CO₂ before treatment,T was-4.620,P < 0.05,and there was a statistical difference in the decrease of Pa CO₂ before and after treatment.Conclusions: The response to hypoxia in respiratory center of OS patients was different from that of COPD patients,and lower than that of COPD patients,while the hypercapnia reactivity of respiratory centers of OS patients was not different from that of COPD patients.After 2 weeks of non-invasive respiratory mechanical ventilation with Bi-PAP,the Pa O₂ and Pa CO₂ were improved compared with those before.It is suggested that the non-invasive ventilator Bi-PAP model has a better clinical effect.