持续气道正压通气治疗急性脑梗死合并OSAHS的效果及作用机制

发布时间：2018-06-21 00:56

本文选题：阻塞性睡眠呼吸暂停综合征 + 脑梗死　；参考：《山东医药》2017年05期

【摘要】：目的观察持续气道正压通气(CPAP)辅助治疗脑梗死合并阻塞性睡眠呼吸暂停综合征(OSAHS)患者的效果,并探讨其作用机制。方法选择脑梗死合并OSASH患者80例,将其随机分为观察组与对照组各40例。对照组给予常规药物治疗与康复治疗,观察组在此基础上给予CPAP治疗,均连续治疗14 d。分别于治疗前后(入院当日、治疗14 d)使用多导睡眠监测仪检测呼吸功能指标:呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSa O2)、氧减饱和度指数(ODI)、低氧持续时间占睡眠总时间百分比;治疗前及治疗14 d、2个月、6个月用经颅彩色多普勒超声检测双侧颅内动脉的血流速度,计算阻力指数(RI);用美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力量表(ADL)评分评估神经功能;治疗后随访6个月记录发生的不良事件。结果治疗后观察组呼吸功能指标均优于对照组(P均0.05)。与治疗前比较,治疗后两组各时间点NIHSS评分、双侧脑动脉RI降低,ADL评分升高(P均0.05),且观察组变化更明显(P均0.05);观察组治疗有效率高于对照组、病死率低于对照组(P均0.05)。观察组不良事件发生率均低于对照组,且再发脑梗死、心血管事件发生率与对照组比较差异有统计学意义(P均0.05)。结论 CPAP辅助治疗脑梗死合并OSAHS有效,其可能通过改善大脑动脉血流从而改善患者的呼吸与神经系统功能。
[Abstract]:Objective to observe the effect of continuous positive airway pressure ventilation (CPAP) in the treatment of patients with cerebral infarction complicated with obstructive sleep apnea syndrome (OSAHS) and to explore its mechanism. Methods Eighty patients with cerebral infarction complicated with OSASH were randomly divided into two groups: the observation group (n = 40) and the control group (n = 40). The control group was given routine drug therapy and rehabilitation, and the observation group was treated with CPAP for 14 days. Before and after treatment (on admission day), After 14 days of treatment, apnea hypopnea index (AHIH), lowest blood oxygen saturation (LSAO _ 2), oxygen desaturation index (ODI), hypoxia duration in total sleep were measured by polysomnography. The blood flow velocities of bilateral intracranial arteries were measured by transcranial color Doppler ultrasound before treatment and 14 days, 2 months and 6 months after treatment, and resistive index (RI) was calculated, and NIHSS scores were evaluated by the National Institutes of Health Stroke scale (NIHSS). The activity of daily living (ADL) score was used to evaluate the neurological function, and the adverse events were recorded 6 months after treatment. Results after treatment, the indexes of respiratory function in the observation group were better than those in the control group (P < 0.05). Compared with before treatment, after treatment, NIHSS scores of bilateral cerebral artery RI decreased and ADL scores increased (P 0.05), and the changes of observation group were more obvious (P < 0.05), the effective rate of treatment in the observation group was higher than that in the control group, and the fatality rate was lower than that in the control group (P < 0.05). The incidence of adverse events in the observation group was lower than that in the control group, and the incidence of recurrent cerebral infarction was significantly lower than that in the control group (P < 0.05). Conclusion CPAP is effective in the treatment of cerebral infarction complicated with OSAHS. CPAP may improve the respiratory and nervous system function by improving the blood flow of cerebral artery.
【作者单位】：沧州市中心医院;
【基金】：沧州市科技计划项目(151302087)
【分类号】：R743.33;R766

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