简单工具在监测接受无创通气治疗的慢性低通气患者中的诊断准确性：一项前瞻性横断面研究。
Diagnostic accuracy of simple tools in monitoring patients with chronic hypoventilation treated with non-invasive ventilation; a prospective cross-sectional study.
机构信息
Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway; University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Long Term Mechanical Ventilation, Haukeland University Hospital, Norway.
Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.
出版信息
Respir Med. 2018 Nov;144:30-35. doi: 10.1016/j.rmed.2018.09.015. Epub 2018 Sep 26.
OBJECTIVES
To evaluate the sensitivity and specificity of a screening test panel for nocturnal hypoventilation (NH) and other sleep related respiratory events during monitoring of patients with chronic hypercapnic respiratory failure (CRF) treated with NIV.
METHODS
We performed a prospective study at Oslo University Hospital. Eligible for inclusion were consecutive adults with CRF due to neuromuscular diseases or chest wall disorders treated with NIV scheduled for a follow-up visit. All patients underwent the screening test panel (clinical evaluation, daytime arterial blood gas (ABG), nocturnal pulse oximetry (SpO) and data from ventilator software) and the reference tests; sleep polygraphy and nocturnal transcutaneous CO.
RESULTS
Of 67 patients included, NH was confirmed in 23-50 according to the 3 definitions used for NH, apnea-hypopnea index (AHI) ≥ 10 was confirmed in 16 and patient-ventilator asynchrony (PVA) ≥ 10% of total recording time in 14. Sensitivity of the combined screening test panel for NH was 87% (95% confidence interval 66-97), 84% (66-95) and 80% (66-90), for abnormal AHI 91% (59-100) and for PVA 71% (42-92). Sensitivity for NH of SpO was 48% (27-69), 39% (22-58) and 38% (24-53) and of daytime ABG 74% (52-90), 74% (55-88) and 68% (53-80). Sensitivity and specificity of AHI for AHI ≥ 10 was 93% (68-100) and 92% (81-98) respectively.
DISCUSSION
In patients treated with long term NIV, screening test panel, nocturnal SpO and daytime ABG all failed to accurately detect NH, underlining the importance of nocturnal monitoring of CO. AHI accurately identified obstructive events and can be used to modify NIV settings.
TRIAL REGISTRATION
N° NCT01845233.
目的
评估夜间低通气（NH）和其他睡眠相关呼吸事件的筛查测试组合在接受慢性高碳酸血症性呼吸衰竭（CRF）患者的 NIV 治疗监测中的敏感性和特异性。
方法
我们在奥斯陆大学医院进行了一项前瞻性研究。符合条件的患者为患有神经肌肉疾病或胸壁疾病的连续成人，因 CRF 接受 NIV 治疗，计划进行随访。所有患者均接受了筛查测试组合（临床评估、日间动脉血气（ABG）、夜间脉搏血氧仪（SpO）和呼吸机软件数据）和参考测试；睡眠多导睡眠图和夜间经皮 CO。
结果
在 67 名纳入的患者中，根据用于 NH 的 3 种定义，有 23-50 名患者确诊 NH，16 名患者确诊呼吸暂停低通气指数（AHI）≥10，14 名患者患者-呼吸机不同步（PVA）≥总记录时间的 10%。用于 NH 的联合筛查测试组合的敏感性为 87%（66-97）、84%（66-95）和 80%（66-90），异常 AHI 的敏感性为 91%（59-100），PVA 为 71%（42-92）。SpO 用于 NH 的敏感性为 48%（27-69）、39%（22-58）和 38%（24-53），日间 ABG 为 74%（52-90）、74%（55-88）和 68%（53-80）。AHI 用于 AHI≥10 的敏感性和特异性分别为 93%（68-100）和 92%（81-98）。
讨论
在接受长期 NIV 治疗的患者中，筛查测试组合、夜间 SpO 和日间 ABG 均未能准确检测 NH，这突出了夜间 CO 监测的重要性。AHI 准确识别阻塞性事件，并可用于调整 NIV 设置。
试验注册
N°NCT01845233。
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