阻塞性睡眠呼吸暂停低通气综合征的诊疗进展.ppt

脉搏及血氧饱和度 REM睡眠低通气 治疗前 治疗后 OSA 治疗目标：维持上气道开放 Flow Pressure Volume CPAP 1981 Flow Pressure Volume BiPAP 1991 Auto-CPAP 1993 呼吸事件 SaO2 气流 Apnea/Hypopnea Snoring Airflow limitation 阻力(高频振荡) 压力发生器 + _ + _ 感受系统 效应系统 AUTO-CPAP Auto-CPAP FOT,Flow,Snoring Artefact detection 反馈信号 监测事件 Central events Volume Contour Obstructive events Severe Obstructions Slight Obstructions Incipient Obstructions Flow Snoring OPS 压力调整 Pressure reaction p Event Snoring及Airflow limitation 标志上气道的狭窄 去除二者后可消除呼吸暂停及低通气 apnea Normal breathing snoring Flow limitation hypopnea Hypopnea Normal 气 流 受 限 (Flow limitation) CSR: Why Does it Occur? Hyperventilation ↓CO2 Apnea ? CO2 Deoxygenation Arousal Apneic Threshold Normal Breathing CSR Pattern 0 5 8 15 Diaphragm EMG Mask Pressure central hyperpnea central hypopnea spontaneous spontaneous timed central hyperpnea Adaptive Servo Ventilation (ASV) 以静息通气量的 90% 为目标通气量 以容量为目标的压力支持通气 有自己的节律 AUTO-BiPAP Enhanced Expiratory Rebreathing Space (Dead space) adjunct to PAP Dead space -400+ patients with complex disease (20+ CHF) - non-vented oronasal mask - 50-150 ml additional DS - immediate good lab control with PAP: 70% (leak and a more recently recognized “sleep effect” are problems - home use is effective in about 60% (these patients are often otherwise virtually untreatable) 呼气末压力释放技术 Mode for home sleep apnea testing Patient 1 2 3 4 5 6 internet Central lab 家庭环境 睡眠过程中监测 同一时间监测例数增加 降低患者花费 提高医疗服务效率和质量 SLEEP APNEA: a model of Homecare 家庭治疗 家庭监测 管理机制 管理经验 管理梯队 睡眠呼吸医学：家庭医疗的先行者 血氧 机器指标 氧浓度 氧流量 病人使用情况 SaO2 心率 生理指标 家庭呼吸机治疗 The Mechanisms of Sleep Apnea Anatomic and/or Functional Pathogenesis of Sleep Apnea Airway Obstruction Small pharyngeal airway Ventilatory control instability Poor upper airway response Low arousal threshold 录象 SLEEP APNEA central obstructive