中枢性睡眠增多患者的动态脑血流自动调节的研究

发布时间：2018-05-23 19:04

本文选题：日间过度嗜睡 + 中枢性睡眠增多　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本研究旨在明确中枢性睡眠增多患者动态脑血流自动调节的变化,并探讨其可能作用的病理生理机制,为指导临床治疗提供更多依据。方法:本研究选取2016年2月到2017年2月期间就诊于吉林大学第一医院神经内科门诊的符合日间过度嗜睡的诊断标准的研究对象21例及健康对照组7例,根据夜间睡眠监测加多次睡眠潜伏期试验检查结果将实验组分为嗜睡组7例、发作性睡病不伴RBD组7例、发作性睡病伴RBD组7例。应用经颅多普勒超声联合连续指尖血压检测仪,无创地同步记录脑血流速度(CBFV)和动脉血压,采用目前公认的传递函数分析(TFA)方法计算导出脑血流自动调节参数:相位差(PD)、增益、相关性,评价脑血流自动调节功能。在发作性睡病患者中,有7例经过至少1个月规范治疗后再次行脑血流调节检查,并与治疗前进行比较。结果:(1)嗜睡组、发作性睡病不伴RBD组、发作性睡病伴RBD组ESS(14.6±3.8、16.4±4.0、18.0±2.9)与对照组数值(2.1±1.3)比较均明显升高,差异均有统计学意义(p0.05)。嗜睡组、发作性睡病不伴RBD组、发作性睡病伴RBD组左相位差(33.97±8.71、35.49±11.72、32.00±13.09)与对照组数值(53.15±7.91)比较均明显下降;嗜睡组、发作性睡病不伴RBD组、发作性睡病伴RBD组右相位差(33.95±9.21、36.58±13.30、31.85±8.77)与对照组数值(53.54±10.87)比较均明显下降,不同组别研究对象的左右相位差差异均有统计学意义(p0.05)。不同组别研究对象的左右增益差异均无统计学意义(p0.05)。发作性睡病伴RBD与不伴RBD相应半球的相位差、增益相比,差异均无统计学意义(p0.05)。(2)发作性睡病治疗前后相比,治疗后ESS(11.3±2.0)较治疗前ESS(15.6±2.7)降低,其差异具有统计学意义(p0.05);治疗后左侧PD(43.9±12.54°)与治疗前左侧PD(24.79±10.13°)相比,PD差异显著增加,差异具有显著统计学意义(p0.05)。治疗后右侧PD(43.05±14.89°),与治疗前左侧PD(25.39±5.50°)相比,PD差异显著增加,具有统计学意义(p0.05),而治疗前后的左右增益差异均无统计学意义(p0.05)。结论:(1)中枢性睡眠增多患者的动态脑血流自动调节功能受损。(2)对于发作性睡病伴RBD与不伴RBD的患者,动态脑血流自动调节功能受损程度无差异,可能有相同的病理生理机制有关。(3)经药物(哌甲酯、氟西汀或文拉法辛)治疗后发作性睡病患者的动态脑血流自动调节功能有所改善。
[Abstract]:Objective: to investigate the changes of dynamic cerebral blood flow automatic regulation in patients with central sleepiness and to explore the pathophysiological mechanism of its possible role in order to provide more evidences for clinical treatment. Methods: from February 2016 to February 2017, 21 subjects who met the diagnostic criteria of daytime excessive somnolence in the Department of Neurology, first Hospital of Jilin University, and 7 healthy controls were selected. According to the results of nocturnal sleep monitoring and multiple sleep latency test, the experimental group was divided into narcolepsy group (n = 7), narcolepsy without RBD group (n = 7) and narcolepsy with RBD group (n = 7). The cerebral blood flow velocity (CBFV) and arterial blood pressure were recorded noninvasively by transcranial Doppler ultrasound combined with continuous fingertip blood pressure detector. The parameters of automatic cerebral blood flow regulation were calculated and derived by using the currently accepted transfer function analysis (TFAA) method: phase difference PDV, gain, and so on. To evaluate the function of cerebral blood flow automatic regulation. Among the patients with paroxysmal narcolepsy, 7 patients underwent cerebral blood flow regulation after at least one month of standardized treatment, and were compared with those before treatment. Results compared with the control group, the contents of ESS(14.6 卤3.8N 16.4 卤4.0 卤18.0 卤2.9 in narcolepsy group, paroxysmal sleepiness group without RBD and paroxysmal sleep disease with RBD group were significantly higher than those in control group (2.1 卤1.3). The difference was statistically significant (P 0.05). In narcolepsy group, the left phase difference of narcolepsy without RBD and paroxysmal sleep with RBD was 33.97 卤8.71 卤35.49 卤11.72 卤32.00 卤13.09) significantly lower than that of control group (53.15 卤7.91), while in narcolepsy group, paroxysmal sleepiness was not associated with RBD. The right phase difference (33.95 卤9.21 卤36.58 卤13.30 卤31.85 卤8.77) in paroxysmal sleepiness with RBD group was significantly lower than that in control group (53.54 卤10.87). There was no significant difference in left and right gain between different groups of subjects (p 0.05). There was no significant difference in the phase difference and gain between paroxysmal sleepiness with RBD and those without RBD. There was no significant difference between the two hemispheres before and after treatment. Compared with before and after treatment, ESS(11.3 卤2.0) was significantly lower than that before and after treatment (ESS(15.6 卤2.7). The difference of PD between left PD(43.9 卤12.54 掳and left PD(24.79 卤10.13 掳after treatment was significantly higher than that before treatment, and the difference was statistically significant (P 0.05). After treatment, the right PD(43.05 卤14.89 掳PD(43.05 was significantly higher than that of the left side PD(25.39 卤5.50 掳(P 0.05), but there was no significant difference in left and right gain before and after treatment. Conclusion (1) there is no difference in the degree of impairment of dynamic cerebral blood flow automatic regulation between patients with paroxysmal sleepiness with RBD and those without RBD. There may be the same pathophysiological mechanism related to .t3) the automatic regulation of dynamic cerebral blood flow in patients with narcolepsy was improved after treatment with drugs (methylphenidate, fluoxetine or venlafaxine).
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R740

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