2018 年第 10 期 第 13 卷

持续无创正压通气对脑卒中合并阻塞性睡眠呼吸暂停低通气综合征患者认知能力和预后的影响

Effect of continuous noninvasive positive pressure ventilation on cognitive function and prognosis in stroke patients with obstructive sleep apnea hypopnea syndrome

作者：卡衣赛尔·卡哈尔李江谭元元史冬梅

英文作者：

单位：830001乌鲁木齐，新疆维吾尔自治区人民医院耳鼻喉科（卡衣赛尔·卡哈尔、谭元元、史冬梅），神经内科（李江）

英文单位：

关键词：阻塞性睡眠呼吸暂停低通气综合征；无创正压通气；卒中；认知能力

英文关键词：

• 摘要：

• 【摘要】目的    探讨持续无创正压通气（CPAP）治疗对脑卒中合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者认知能力和预后的影响。方法    选择2015年10月至2017年12月新疆维吾尔自治区人民医院诊治的脑卒中合并OSAHS患者98例，其中在康复治疗基础上接受CPAP治疗48例（观察组），仅进行康复治疗50例（对照组）。比较2组患者治疗前和治疗12周后睡眠呼吸相关指标、脑部血流动力学指标、炎性递质水平、认知功能、预后相关指标和临床不良事件及结局的差异。结果    治疗前，2组患者的睡眠呼吸相关指标、脑部血流动力学指标、炎性递质水平、认知功能比较差异均无统计学意义（均P＞0.05）。治疗12周后，2组患者的呼吸暂停低通气指数、Ep-worth嗜睡量表评分均低于治疗前，且观察组低于对照组［（10±4）次/h比（12±5）次/h，（6±3）分比（9±4）分］（均P<0.05）；最低动脉血氧饱和度水平均高于治疗前，且观察组高于对照组［（87±4）%比（84±4）%］（均P<0.05）；大脑中动脉搏动指数、C反应蛋白、白细胞介素6水平均低于治疗前，且观察组的大脑中动脉搏动指数、C反应蛋白均低于对照组［（0.85±0.09）比（0.91±0.11），（1.6±0.3）mg/L比（2.2±0.4）mg/L］（均P<0.05）；大脑中动脉平均流速均高于治疗前，且观察组高于对照组［（65.0±3.3）cm/s比（51.3±3.1）cm/s］（均P<0.05）；蒙特利尔认知评估量表、Loewenstein认知功能评定量表评分和简易精神状态检查量表评分均高于治疗前，且观察组高于对照组［（24.0±1.4）分比（20.3±1.5）分，（74±8）分比（69±8）分，（27±3）分比（23±3）分］（均P<0.05）。治疗期间，观察组脑卒中复发率、心血管事件发生率、病死率均明显低于对照组［4.2%(2/48)比18.0%（9/50），6.2%(3/48)比24.0%（12/50），2.1%(1/48)比14.0%（7/50）］，差异均有统计学意义（均P<0.05）。结论    及时、正确地应用CPAP对改善脑卒中合并OSAHS患者的认知功能障碍和预后具有重要意义。

• 【Abstract】Objective    To investigate the effect of continuous noninvasive positive airway pressure(CPAP) on cognitive function and prognosis in patients with stroke and obstructive sleep apnea hypopnea syndrome(OSAHS). Methods    A total of 98 stroke patients with OSAHS were enrolled from October 2015 to December 2017 at People′s Hospital of Xinjiang Uygur Autonomous Region. On the basis of rehabilitation therapy, 48 patients were treated with CPAP(observation group); 50 patients had no additional treatment(control group). Sleep-breathing indicators, cerebral hemodynamics, inflammatory mediators, cognitive function, prognostic indicators and clinical adverse events were analyzed before and 12 weeks after treatment. Results    Before treatment, sleep-breathing, cerebral hemodynamics, inflammatory indicators and cognitive function were similar between the two groups(P>0.05). After 12 weeks of treatment, apnea hypopnea index and the score of Ep-worth Sleepiness Scale were significantly lower than those before treatment and there were significant differences between the observation group and control group［(10±4)times/h vs (12±5)times/h, (6±3) vs (9±4)］(P<0.05). The lowest oxygen saturation significantly increased compared to that before treatment; the lowest oxygen saturation in the observation group was significantly higher than that in the control group［(87±4)% vs (84±4)%］(P<0.05). Pulsatility index of middle cerebral artery, levels of C-reactive protein and interleukin-6 were significantly lower than those before treatment; middle cerebral artery pulsatility index and C-reactive protein level in the observation group were significantly lower than those in the control group［(0.85±0.09) vs (0.91±0.11), (1.6±0.3)mg/L vs (2.2±0.4)mg/L］(P<0.05). The mean flow velocity of middle cerebral artery was significantly higher than that before treatment; the mean flow velocity of middle cerebral artery in the observation group was significantly higher than that in the control group［(65.0±3.3) cm/s vs (51.3±3.1)cm/s］(P<0.05). Scores of Montreal Cognitive Assessment Scale, Loewenstein Occupational Therapy Cognitive Assessment Scale and Simple Intelligent State Scale were significantly higher than those before treatment; the scores in the observation group were significantly higher than those in the control group［(24.0±1.4) vs (20.3±1.5), (74±8) vs (69±8), (27±3) vs (23±3)］(P<0.05). During treatment, incidences of recurrent stroke, cardiovascular events and the mortality rate in the observation group were significantly lower than those in the control group［4.2%(2/48) vs 18.0%(9/50), 6.2%(3/48) vs 24.0%(12/50), 2.1%(1/48) vs 14.0%(7/50)］(P<0.05). Conclusion    Rational application of CPAP can improve the cognitive function and prognosis in stroke patients with OSAHS.