无创正压通气治疗138例慢性阻塞性肺疾病急性加重合并阻塞性睡眠呼吸暂停临床疗效分析

doi:10.3877/cma.j.issn.1674-6902.2026.02.008

目的

探讨无创正压通气(non-invasive positive pressure ventilation, NIPPV)治疗慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)合并阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)患者的临床疗效。

方法

回顾性选择2022年4月至2025年12月我院收治的AECOPD合并OSA患者138例为对象，按住院期间NIPPV治疗效果分组，治疗有效93例为观察组，无效45例为对照组。收集两组临床资料、动脉血气分析、睡眠监测及通气参数等。采用单因素及多因素Logistic回归分析影响疗效的因素。

结果

单因素分析显示，身体质量指数(body mass index, BMI)、动脉血二氧化碳分压(partial pressure of arterial carbon dioxide, PaCO₂)、呼气末正压(positive end-expiratory pressure, PEEP)、NIPPV启动延迟时间、夜间通气策略、呼吸暂停低通气指数(apnea-hypopnea index, AHI)及最低脉搏血氧饱和度(minimum pulse oxygen saturation, miniSpO₂)与NIPPV疗效相关(P<0.05)。多因素Logistic回归分析显示，BMI(OR＝0.87，P＝0.024)、PaCO₂(OR＝0.94，P＝0.006)及AHI(OR＝0.91，P＝0.005)为危险因素；ΔPEEP增量(OR＝1.88，P＝0.004)、较短NIPPV延迟时间(OR＝0.78，P＝0.019)、夜间主动上调PEEP(OR＝4.26，P＝0.002)及较高miniSpO₂(OR＝1.12，P＝0.009)为保护因素。受试者工作特征(receiver operating characteristic, ROC)曲线下面积(area under the curve, AUC)为0.839。

结论

BMI、PaCO₂及AHI高，夜间适度增加PEEP、早期启动NIPPV及高氧饱和度可提高AECOPD合并OSA患者NIPPV治疗效果。优化通气参数及干预时机对改善患者通气效率和睡眠质量具有临床意义。

关键词: 肺疾病，慢性阻塞性, 睡眠呼吸暂停，阻塞性, 无创通气, 呼吸衰竭，高碳酸血症性, 呼气末正压

Objective

To investigate the factors influencing the efficacy of non-invasive positive pressure ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with obstructive sleep apnea (OSA), and to evaluate the clinical value of different nocturnal ventilation strategies.

Methods

A retrospective analysis was conducted on 138 patients with AECOPD complicated by OSA admitted to our hospital from April 2022 to December 2025. Based on the therapeutic effect of NIPPV during hospitalization, patients were divided into two groups: 93 cases in the observation group (effective treatment) and 45 cases in the control group (ineffective treatment). General data, arterial blood gas parameters, sleep monitoring data, and ventilation parameters were collected from both groups. Univariate and multivariate logistic regression analyses were used to identify factors influencing the therapeutic effect.

Results

Univariate analysis showed that body mass index (BMI), arterial partial pressure of carbon dioxide (PaCO₂), positive end-expiratory pressure (PEEP), NIPPV initiation delay time, nocturnal ventilation strategy, apnea-hypopnea index (AHI), and minimum pulse oxygen saturation (miniSpO₂) were associated with the efficacy of NIPPV (P<0.05). Multivariate logistic regression analysis revealed that BMI (OR=0.87, P=0.024), PaCO₂ (OR=0.94, P=0.006), and AHI (OR=0.91, P=0.005) were negative predictors; whereas ΔPEEP increment (OR=1.88, P=0.004), shorter NIPPV delay time (OR=0.78, P=0.019), active nocturnal PEEP up-titration (OR=4.26, P=0.002), and higher miniSpO₂ (OR=1.12, P=0.009) were protective factors. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.839.

Conclusion

High BMI, PaCO₂, and AHI, moderate nocturnal increase in PEEP, early initiation of NIPPV, and high oxygen saturation can improve the therapeutic effect of NIPPV in patients with AECOPD combined with OSA. Optimizing ventilation parameters and intervention timing has clinical significance for enhancing ventilation efficiency and sleep quality in these patients.

Key words: Chronic obstructive pulmonary disease, Obstructive sleep apnea, Non-invasive ventilation, Hypercapnic respiratory failure, Positive end-expiratory pressure

表1 两组AECOPD合并OSA患者临床资料结果

临床资料	观察组(n＝93)	对照组(n＝45)	t/χ²值	P值
BMI[kg/m²，(±s)]	24.65±2.87	26.21±3.12	－2.825	0.004
COPD病程[年，(±s)]	10.45±4.83	11.13±5.02	－0.755	0.471
吸烟指数[包/年，(±s)]	41.75±15.24	44.23±14.62	－0.921	0.385
pH(±s)	7.31±0.05	7.28±0.06	2.902	0.018
PaO₂[mmHg, (±s)]	58.63±9.41	56.84±8.75	1.099	0.243
PaCO₂[mmHg, (±s)]	58.31±8.13	64.56±9.22	－3.877	0.000
高血压[n(%)]	37 (39.78)	21 (46.67)	0.590	0.457
糖尿病[n(%)]	19 (20.43)	12 (26.67)	0.677	0.425
冠心病[n(%)]	15 (16.13)	9 (20.00)	0.316	0.565
ΔPEEP(cmH₂O)	2.83±0.94	1.97±0.86	5.340	0.003
NIPPV延迟时间(h)	4.21±1.75	6.12±2.35	－4.842	0.002
夜间主动上调PEEP[n(%)]	61 (65.59)	15 (33.33)	12.757	0.000

表1 两组AECOPD合并OSA患者临床资料结果

临床资料	观察组(n＝93)	对照组(n＝45)	t/χ²值	P值
BMI[kg/m²，(±s)]	24.65±2.87	26.21±3.12	－2.825	0.004
COPD病程[年，(±s)]	10.45±4.83	11.13±5.02	－0.755	0.471
吸烟指数[包/年，(±s)]	41.75±15.24	44.23±14.62	－0.921	0.385
pH(±s)	7.31±0.05	7.28±0.06	2.902	0.018
PaO₂[mmHg, (±s)]	58.63±9.41	56.84±8.75	1.099	0.243
PaCO₂[mmHg, (±s)]	58.31±8.13	64.56±9.22	－3.877	0.000
高血压[n(%)]	37 (39.78)	21 (46.67)	0.590	0.457
糖尿病[n(%)]	19 (20.43)	12 (26.67)	0.677	0.425
冠心病[n(%)]	15 (16.13)	9 (20.00)	0.316	0.565
ΔPEEP(cmH₂O)	2.83±0.94	1.97±0.86	5.340	0.003
NIPPV延迟时间(h)	4.21±1.75	6.12±2.35	－4.842	0.002
夜间主动上调PEEP[n(%)]	61 (65.59)	15 (33.33)	12.757	0.000

图1 两组AECOPD合并OSA患者胸部影像学结果。图A、B为观察组治疗前CT影像学结果；图C、D为对照组治疗前后CT影像学结果

表2 两组AECOPD合并OSA患者血气分析结果(

±s)

血气指标	时　相	观察组(n＝93)	对照组(n＝45)	P值
pH	入院时	7.31±0.05	7.28±0.06	0.018
	72 h	7.36±0.04	7.31±0.05	0.011
PaO₂(mmHg)	入院时	58.66±9.45	56.84±8.73	0.243
	72 h	69.14±8.73	67.34±8.62	0.142
PaCO₂(mmHg)	入院时	58.36±8.13	64.54±9.22	0.000
	72 h	49.36±6.54	56.87±8.03	0.000
miniSpO₂(%)	入院时	86.12±4.35	85.41±4.56	0.517
	72 h	91.85±3.63	89.25±3.94	0.028

表2 两组AECOPD合并OSA患者血气分析结果(

±s)

血气指标	时　相	观察组(n＝93)	对照组(n＝45)	P值
pH	入院时	7.31±0.05	7.28±0.06	0.018
	72 h	7.36±0.04	7.31±0.05	0.011
PaO₂(mmHg)	入院时	58.66±9.45	56.84±8.73	0.243
	72 h	69.14±8.73	67.34±8.62	0.142
PaCO₂(mmHg)	入院时	58.36±8.13	64.54±9.22	0.000
	72 h	49.36±6.54	56.87±8.03	0.000
miniSpO₂(%)	入院时	86.12±4.35	85.41±4.56	0.517
	72 h	91.85±3.63	89.25±3.94	0.028

表3 两组AECOPD合并OSA患者睡眠及量表评分比较(

±s)

临床指标	观察组(n＝93)	对照组(n＝45)	t值	P值
睡眠效率(%)	84.67±6.76	77.95±8.23	4.756	0.004
AHI(次/1 h)	10.34±4.85	17.96±5.35	－8.084	0.002
miniSpO₂(%)	86.76±5.13	80.32±6.44	5.868	0.003
ESS评分	7.23±2.85	10.52±3.14	－5.943	0.005
Borg评分	2.93±0.85	4.15±1.03	－6.888	0.003
HRQL评分	81.64±5.96	75.24±6.33	5.674	0.007

表3 两组AECOPD合并OSA患者睡眠及量表评分比较(

±s)

临床指标	观察组(n＝93)	对照组(n＝45)	t值	P值
睡眠效率(%)	84.67±6.76	77.95±8.23	4.756	0.004
AHI(次/1 h)	10.34±4.85	17.96±5.35	－8.084	0.002
miniSpO₂(%)	86.76±5.13	80.32±6.44	5.868	0.003
ESS评分	7.23±2.85	10.52±3.14	－5.943	0.005
Borg评分	2.93±0.85	4.15±1.03	－6.888	0.003
HRQL评分	81.64±5.96	75.24±6.33	5.674	0.007

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Clinical efficacy analysis of noninvasive positive pressure ventilation in the treatment of acute exacerbation of 138 patients of chronic obstructive pulmonary disease combined with obstructive sleep apnea

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Clinical efficacy analysis of noninvasive positive pressure ventilation in the treatment of acute exacerbation of 138 patients of chronic obstructive pulmonary disease combined with obstructive sleep apnea