一般而言,睡眠呼吸暂停综合征患者需终身使用CPAP呼吸机,因而有以下问题需要考虑。
(1)CPAP呼吸机的使用寿命、维修及服务。
目前CPAP使用寿命一般超过5年,而BiPAP可能超过10年。好的供货商在维修及服务上都有保证。
(2)患者对CPAP呼吸机的长期耐受性。
长期使用率一般为60-80% ,因此其长期使用率仍待提高。影响患者长期使用的因素一般有以下几方面:
机器的性能:如果CPAP呼吸机噪音低,体积小携带方便,性能优良,则病人坚持使用率就高,反之,则不然。
患者病情的不同:经常外出的患者长期坚持应用CPAP呼吸机有困难;在治疗的过程中患者体重明显增加、饮酒等都会使克服睡眠呼吸暂停所需压力增加,如果不及时调整可致治疗失败;病情重的患者,病状较多,治疗愿望较强烈,易长期坚持使用,而病情较轻者,长期应用CPAP呼吸机的失败率较高。
有关睡眠呼吸暂停综合征的知识甚少,对其危害性认识不足,认为治不治都无所谓。这是一些患者不能长期使用的一个主要原因,应向病人透彻讲解,让病人明了其严重危害性,让病人从思想上接受CPAP呼吸机的长期治疗。
(3)应用CPAP呼吸机能否彻底治愈睡眠呼吸暂停综合征。
除少数病例外,睡眠呼吸暂停综合征患者需终身使用CPAP呼吸机。这是因为睡眠是咽部的狭窄或塌陷是一个生理的改变,任何人都不例外,只不过个体对缺氧的敏感性不同,有些人轻、有些人重而已。当然经过一段时间的有效治疗,短期暂时地不使用呼吸机是可行的。这期间,病人呼吸暂停消失或发生率明显下降,但长期不再使用是完全不行的,长期不用病情反复甚至进一步加重,CPAP呼吸机治疗后,病情的改善与以下因素有关。
睡眠呼吸暂停综合征患者,由于长期打鼾,上气道水肿明显,加重了上气道阻塞,治疗后,上气道的水肿减轻或消失,自然有所改善。
患者长期睡眠结构紊乱,上气道肌肉的活动功能下降,经CPAP呼吸机治疗后,睡眠结构恢复正常,3-4天后即可出现上呼吸道肌肉活动功能增强。
CPAP呼呼吸机治疗可以提高患者呼吸控制功能,增加其呼吸中枢对各种刺激的敏感性,减少睡眠呼吸暂停的发生。
经过CPAP呼吸机治疗,患者由于长期缺氧及睡眠紊乱引起的内分泌,代谢紊乱消失,机体内的许多内分泌激素恢复正常。
睡眠呼吸暂停综合征治疗过程中的随访:
CPAP呼吸机治疗失败的原因是由于机器性能不好,或医生未能及时随诊处理好病人遇到的问题所致。如果机器性能不好,那么换一台性能好的就很容易解决了。因此医生的随诊访就非常重要。睡眠呼吸暂停综合征一般需终身使用CPAP呼吸机治疗,随着年龄增长,各项机能都趋向哀退,可能合并其他疾病,生活习惯的临时性或永久性改变,服用镇静安眠药物,劳累等等因素都可能加重病情或使病情起伏,因而需及时调整CPAP呼吸机的治疗,否则患者未在指导下使用CPAP,长期治疗成功率几乎为零。因而医生应定期随访患者,详细了解病人情况,进行有效的治疗调整。另外,也应定期用多导仪对病人疗效进行判断。也可由为您提供呼吸机的家庭服务公司协助医生为您提供全方位的售后服务。
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