2026 年第 5 期 第 21 卷

海拔高度对慢性心力衰竭患者动脉血二氧化碳分压水平和中枢型睡眠呼吸暂停发生情况的影响

Effects of altitude on arterial partial pressure of carbon dioxide and the incidence of central sleep apnea in patients with chronic heart failure

作者：李群1贡布2王晓霞1陈鹏1,2

英文作者：Li Qun1 Gong Bu2 Wang Xiaoxia1 Chen Peng12

单位：1四川省成都市第三人民医院呼吸与危重症医学科，成都610000；2四川省理塘县人民医院内儿科，甘孜藏族自治州627550

英文单位：1Department of Respiratory and Critical Care Medicine the Third People′s Hospital of Chengdu Sichuan Province Chengdu 610000 China; 2Department of Pediatric Internal Medicine Litang County People′s Hospital Sichuan Province Ganzi Tibetan Autonomous Prefecture 627550 China

关键词：慢性心力衰竭；中枢型睡眠呼吸暂停；动脉血二氧化碳分压

英文关键词：Chronicheartfailure;Centralsleepapnea;Arterialpartialpressureofcarbondioxide

• 摘要：

• 目的 分析不同海拔地区慢性心力衰竭患者动脉血二氧化碳分压（PaCO2）水平、中枢型睡眠呼吸暂停（CSA）发生情况差异，探讨CSA发生的相关影响因素。方法 选取四川省成都市第三人民医院（患者均为平均海拔500 m居住居民，低海拔组，48例）和四川省理塘县人民医院（患者均为海拔3 900～4 100 m连续居住≥5年居民，高海拔组，30例）2022年1月至2025年3月收治的共计78例慢性心力衰竭患者。收集患者临床资料及相关临床指标，采用多因素Logistic回归分析筛选CSA的独立危险因素；采用两因素方差分析评估PaCO2和海拔对中枢性睡眠呼吸暂停指数（CSAI）、微觉醒指数（MAI）、Epworth嗜睡量表（ESS）评分的影响；绘制受试者工作特征（ROC）曲线分析PaCO2对不同海拔不同心力衰竭部位患者发生CSA的预测效能。结果 多因素Logistic回归分析表明，左心衰竭、左心室射血分数≤40%、PaCO2≤38 mmHg（1 mmHg＝0.133 kPa）以及三尖瓣环收缩期位移≤12 mm均为发生CSA的独立危险因素（均P<0.05）。无论PaCO2如何，不同海拔组间CSAI、ESS评分差异均有统计学意义（均P<0.001），随着海拔增加，CSAI、ESS评分逐渐增加，二者对CSAI的影响具有交互效应（均P＜0.001）。无论海拔如何，不同PaCO2组间MAI差异均有统计学意义（P<0.001），随着PaCO2的增加，MAI逐渐增加，二者对CSAI的影响具有交互效应（P<0.001）。ROC曲线结果显示，当PaCO2≤36.8 mmHg时，预测左心衰竭患者发生CSA的曲线下面积（AUC）为0.918，当PaCO2≤35.2 mmHg时，预测右心衰竭患者发生CSA的AUC值为1.000。对高海拔地区患者，当PaCO2≤36.9 mmHg时，预测左心衰竭患者发生CSA的AUC为0.964，当PaCO2≤36.0 mmHg时，预测右心衰竭患者发生CSA的AUC为0.972。结论 海拔与PaCO2对慢性心力衰竭患者CSA相关指标有交互影响，高海拔环境CSA风险更高，PaCO2可作为预测CSA的重要指标。

• Objective To analyze the differences in arterial partial pressure of carbon dioxide (PaCO2) and the incidence of central sleep apnea (CSA) in patients with chronic heart failure (CHF) at different altitudes, and to explore the related influencing factors for the occurrence of CSA. Methods A total of 78 CHF patients admitted from January 2022 to March 2025 were enrolled, including 48 cases from the Third People′s Hospital of Chengdu, Sichuan Province (residents living at a mean altitude of 500 m, low-altitude group) and 30 cases from Litang County People′s Hospital, Sichuan Province (residents living continuously at an altitude of 3 900-4 100 m for ≥ 5 years, high-altitude group). The clinical data and relevant clinical indicators of the patients were collected. Multivariate Logistic regression analysis was used to screen the independent risk factors for CSA. Two-way analysis of variance was adopted to evaluate the effects of PaCO2 and altitude on the central sleep apnea index (CSAI), micro-arousal index (MAI) and Epworth sleepiness scale (ESS) score. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive efficacy of PaCO2 for CSA in CHF patients with different heart failure locations at different altitudes. Results Multivariate Logistic regression analysis showed that left heart failure, left ventricular ejection fraction ≤40%, PaCO2 ≤38 mmHg and tricuspid annular systolic excursion ≤12 mm were all independent risk factors for CSA (all P<0.05). Regardless of PaCO2 levels, there were statistically significant differences in CSAI and ESS scores between the different altitude groups (all P<0.001). CSAI and ESS scores increased gradually with the elevation of altitude, and there was an interactive effect of altitude and PaCO2 on CSAI (all P<0.001). Regardless of altitude, there was a statistically significant difference in MAI between the different PaCO2 groups (P<0.001). MAI increased gradually with the rise of PaCO2, and altitude and PaCO2 had an interactive effect on CSAI (P<0.001). ROC curve analysis showed that when PaCO2 ≤36.8 mmHg, the area under the curve (AUC) for predicting CSA in patients with left heart failure was 0.918; when PaCO2 ≤35.2 mmHg, the AUC for predicting CSA in patients with right heart failure was 1.000. For patients in the high-altitude area, when PaCO2 ≤36.9 mmHg, the AUC for predicting CSA in patients with left heart failure was 0.964; when PaCO2 ≤36.0 mmHg, the AUC for predicting CSA in patients with right heart failure was 0.972. Conclusion Altitude and PaCO2 have an interactive effect on CSA-related indicators in CHF patients. The risk of CSA is higher in the high-altitude environment, and PaCO2 can serve as an important indicator for predicting CSA.