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目的:研究阻塞性睡眠呼吸暂停(obstructivesleepapnea,OSA)患者血浆中一氧化碳及间接胆红素(间胆)水平变化及其临床意义。方法:测定111例OSA患者和30名正常人血浆一氧化碳和间胆水平。其中20例中、重度患者使用持续气道内正压通气(continuousairwaypositivepressure,CPAP)呼吸机治疗30日,于治疗前、治疗第一日、治疗1个月后分别测定一氧化碳和间胆水平。结果:①OSA患者血浆中一氧化碳水平显著高于正常人,重度组一氧化碳水平显著高于轻、中度组,OSA合并高血压组的一氧化碳水平亦显著高于无伴高血压组(均为P<0.05);②正常人血浆中间胆水平显著高于OSA患者;轻、中度组间胆水平显著高于重度组,OSA无伴高血压组血浆间胆显著高于合并高血压组;③20例OSA患者血浆一氧化碳于治疗1个月后显著降低,间胆则显著升高(均为P<0.05);④OSA患者血浆中一氧化碳与舒张压和动脉血氧饱和度小于0.90占总睡眠时间比值均呈正相关,血间胆与动脉血氧饱和度小于0.90占总睡眠时间比值和呼吸暂停低吸气指数均呈负相关,一氧化碳与间胆呈负相关。结论:低血氧是引起OSA患者一氧化碳显著增高或间胆显著降低的原因,一氧化碳和间胆都可能参与了OSA的病理生理过程,患者血浆中一氧化碳和间胆水平可考虑作为考察其是否有合并症的指标。
Objective: To study the changes of plasma levels of carbon monoxide and indirect bilirubin in patients with obstructive sleep apnea (OSA) and its clinical significance. Methods: Plasma levels of CO and B were measured in 111 OSA patients and 30 healthy controls. Twenty patients with moderate or severe were treated with continuousairway positive pressure ventilation (CPAP) for 30 days. Before treatment, on the first day of treatment and after one month of treatment, the levels of carbon monoxide and gallbladder were measured respectively. Results: ① The plasma levels of carbon monoxide in patients with OSA were significantly higher than those in normal controls. The levels of carbon monoxide in patients with severe OSA were significantly higher than those in patients with mild to moderate OSA. The levels of CO in OSA patients with hypertension were significantly higher than those in patients without OSA (P <0.05) ); ② The plasma bile level in normal people was significantly higher than that in OSA patients; the bile level in mild and moderate group was significantly higher than that in severe group; the plasma Bile in OSA group was significantly higher than that in hypertension group; (P <0.05). (4) Plasma carbon monoxide in OSA patients was positively correlated with the ratio of diastolic blood pressure and arterial oxygen saturation less than 0.90 to the total sleep time, Interheterochymal and arterial oxygen saturation less than 0.90 as a percentage of total sleep time and apnea hypopnea index were negatively correlated, carbon monoxide and the gall was negatively correlated. CONCLUSIONS: Hypoxemia is responsible for the significant increase of carbon monoxide or significant decrease of inter-gall bladder in patients with OSA. Both carbon monoxide and gallbladder may be involved in the pathophysiological process of OSA. Plasma carbon monoxide and inter-gall bladder level may be considered as a measure of whether they have been combined Symptoms of the disease.