匹配压力支持伺服通气在重度心力衰竭合并陈-施呼吸患者中的应用

目的:探讨匹配压力支持伺服通气(ASV)治疗重度心力衰竭的疗效与安全性。方法:选取重度心力衰竭合并陈-施呼吸(CSR)患者31例,随机分为ASV组(16例)和持续气道正压通气(CPAP)组(15例),治疗4周后比较2组心功能相关指标、睡眠呼吸及睡眠结构和质量相关参数及并发症发生情况。结果:治疗后2组左心室射血分数(LVEF)和6 min步行距离均显著高于治疗前(均P0.05);且血浆B型脑钠肽前体(pro-BNP)水平均显著低于治疗前(均P0.05或P0.01);血浆pro-BNP和6 min步行试验改善情况,ASV组明显优于CPAP组(P0.01)。ASV能明显改善呼吸暂停低通气指数(AHI)、最低血氧饱和度、微觉醒指数、Ⅰ+Ⅱ期睡眠比率、Ⅲ+Ⅳ期睡眠比率、快动眼睡眠比率及睡眠效率(均P0.05),而CPAP只明显改善AHI和最低血氧饱和度,且改善程度CPAP组明显低于ASV组(P0.05或P0.01)。ASV组气胸发生率显著低于CPAP组(P0.05)。结论:ASV可明显改善伴CSR的重症心力衰竭患者的心功能和睡眠呼吸紊乱,且不增加并发症的发生率。     

持续气道正压通气对慢性心力衰竭Cheyne-Stoke呼吸的作用

目的比较单纯氧疗与持续气道正压通气（CPAP）对慢性心力衰竭（CHF）患者Cheyne-Stokes呼吸（CSR）的治疗效果。方法对存在CSR的患者分别进行单纯氧疗及CPAP。结果 53.8%CHF有着CSR。14例存在CSR患者接受氧疗以及CPAP治疗。单纯氧疗与CPAP均显著降低AHI,CPAP的效果优于氧疗效果。氧疗与CPAP治疗后夜间最低血氧饱和度均显著升高,夜间血氧饱和度〈90%时间占总记录时间百分比均改善,总睡眠时间均明显增加,睡眠效率也均改善。结论 CHF患者Cheyne-Stoke呼吸的发生率很高,而氧疗及CPAP可作为治疗CHF患者CSR的有效方法。     

CPAP对阻塞性睡眠呼吸暂停低通气综合征患者认知功能及AHI、LSaO2的影响

目的分析持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者认知功能及呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO₂)的影响。 方法选择2020年9月至2021年9月我院收治的OSAHS患者78例,随机分为观察组40例和对照组38例。对照组给予鼻导管普通氧疗治疗,观察组给予CPAP治疗。比较两组患者的临床疗效、AHI、LSaO₂、蒙特利尔认知评估量表(MoCA)、Loewenstein认功能评定量表(LOTCA)、简易精神状态检查量表(MMSE)、醒觉指数、夜间正常呼吸频率间期标准差(SDNN)、相邻呼吸频率间期均方根(rMMSD)变化情况。 结果观察组40例,显效29例(72.50%),有效7例(17.50%),总有效率90.00%高于对照组71.05%(P<0.05);治疗后,两组AHI、LSaO₂有改善,观察组AHI低于对照组,LSaO₂高于对照组(P<0.05);治疗后,两组认知功能水平有改善,观察组MoCA 、LOTCA 、MMSE评分高于对照组(P<0.05);治疗后,两组醒觉指数、SDNN、rMMSD有改善(P<0.05)。 结论CPAP治疗OSAHS患者效果显著,可有效改善患者认知功能及AHI、LSaO₂水平。     

首次CPAP压力滴定对有和无日间嗜睡OSAHS患者的治疗效果差异及分析

目的 探讨首次持续气道正压通气(CPAP)压力滴定对有和无日间嗜睡症状的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者夜间睡眠结构及主观睡眠感受的治疗效果。方法 纳入经整夜多导睡眠图监测确诊的中-重度OSAHS患者[呼吸暂停低通气指数(AHI)≥15次/h]136例。首次平均睡眠潜伏期(MSL)<10 min定义为嗜睡组，MSL≥10 min为无嗜睡组。结果 与嗜睡组相比，无嗜睡组年龄大[(45.7±12.2)岁vs.(56.9±12.7)岁],CPAP治疗前睡眠潜伏期长[4.0(1.6,7.0) min vs.8.5(5.1,16.0)min],总睡眠时间短[471.8(455.4,496.8) min vs.441.5(394.2,475.5)min](均P<0.05)。两组间体质指数、腰臀比、共病率(高血压、冠心病、糖尿病)差异无统计学意义。经首次CPAP压力滴定治疗后，两组患者AHI降低，1期睡眠减少，快动眼睡眠期、3期睡眠增加，最低和平均血氧饱和度升高(均P<0.05);嗜睡组MSL延长，无嗜睡组主观入睡后觉醒次数减少(P<0.05);CPAP治疗前...     

适应性伺服通气治疗复杂性睡眠呼吸暂停综合征的长期疗效分析

目的 探讨适应性伺服通气(adaptive servo ventilation,ASV)治疗复杂性睡眠呼吸暂停综合征(complex sleep apnea syndrome,CompSAS)的长期疗效.方法 收集2014年6月至2016年6月在民航总医院睡眠中心诊断为CompSAS且愿意接受长期(90 d以上)ASV治疗的患者.于治疗前、持续气道正压通气(continuous positive airway pressure,CPAP)滴定、ASV滴定及ASV治疗90 d时进行睡眠呼吸监测,观察长期ASV治疗对睡眠结构及睡眠呼吸事件的改变;分析长期ASV治疗依从性及相关不良事件.结果 本研究共收集42例CompSAS患者,其中接受长期ASV治疗的患者共有22例.该22例CompSAS患者均为男性,均患有严重OSAHS,平均睡眠呼吸暂停低通气指数(apnea hyponea index,AHI)为(45.76±10.08)次/h;其中平均仰卧位AHI达(55.76±8.25)次/h.左室射血分数大致正常.经过CPAP滴定治疗CompSAS患者AHI、阻塞性睡眠呼吸暂停指数(obstructive apnea index,OAI)、混合性睡眠呼吸暂停指数(mix apnea index,MAD较治疗前显著下降,中枢性睡眠呼吸暂停指数(central apnea index,CAI)较治疗前显著升高;最低血氧饱(lowest oxygen saturation,LSpO2)和度较治疗前显著升高;快动眼(rapid eye movement,REM)睡眠比例较治疗前显著增加.与治疗前及CPAP滴定治疗时相比,ASV滴定及ASV治疗90 d时N3期显著增加,N1期+N2期显著降低;AHI、CAI及MAI均显著降低;LSpO2显著升高.此外,与CPAP滴定时比较,ASV滴定及ASV治疗90 d时睡眠效率显著提高;与治疗前比较,REM期在ASV滴定及ASV治疗90 d时显著提高.长期治疗过程中,ASV平均使用时间为4.8 h/晚.3例患者曾有胸闷表现,调整治疗后胸闷消失.结论 对于无严重心肺疾病及脑血管病的CompSAS患者,ASV长期治疗几乎完全能够消除睡眠呼吸事件,提高睡眠质量,患者依从性好且未见严重不良反应.     

持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征64例疗效观察

目的探讨持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的作用。方法报告了暨南大学第二临床医学院2001-2003年运用多导睡眠图(PSG)及CRAP对64例阻塞性睡眠呼吸暂停低通气综合征患者治疗前后的呼吸紊乱指数(AHI)、最低血氧饱和度、平均血氧饱和度等进行观察。结果治疗前和治疗后AHI每小时(54.1±46.8,3.3±4.8)次;最低血氧饱和度(67.7±10.5,82.4±8.7)%;平均血氧饱和度(88.4±5.9,94.1±1.96)%,治疗后差异有极显著意义(P<0.01)。结论CPAP能显著改善病人的临床症状及治疗病人的夜间低氧血症,CPAP是一种有效的治疗阻塞性睡眠呼吸暂停低通气综合征的方法。     

无创正压通气对睡眠呼吸暂停综合征早期肾损害的疗效观察

目的观察无创正压通气(CPAP)治疗睡眠呼吸暂停综合症(OSAHS)早期肾损害敏感指标前后变化的临床意义。方法分析2013年8月至2014年10月在我院接受治疗的OSAHS早期肾损害患者(呼吸暂停低通气指数AHI≥5)的临床资料。根据是否采用CPAP治疗将入选者分成治疗组和对照组两组。比较两组患者的基线资料、治疗前后肾功能指标表达的变化及睡眠呼吸参数检查结果、ESS评分。结果本研究共纳入66例研究对象,其中治疗组和对照组各33例。两组患者的基线资料无统计学差异(P0.05)。治疗组治疗后的肾功能各指标水平明显低于对照组(P均0.05);两组患者治疗后各肾功能指标水平明显低于治疗前(P均0.05)。治疗组患者治疗前、后的睡眠呼吸参数检查结果以及ESS评分差异显著(P均0.05);且治疗后两组患者的睡眠呼吸参数检查结果以及ESS评分有统计学差异(P均0.05)。结论 CPAP治疗OSAHS早期肾损害患者的临床疗效显著,值得推广。     

阻塞性睡眠呼吸暂停患者残余嗜睡与中枢性睡眠呼吸暂停事件的相关性

目的 探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者连续气道正压通气(continuous positive airway pressure,CPAP)治疗后残余嗜睡与中枢性睡眠呼吸暂停(central sleep apnea,CSA)事件的相关性以及匹配伺服通气(adaptive Bervo-ventilation,ASV)对CSA相关残余嗜睡的影响. 方法 选择正规使用CPAP治疗且排除其他嗜睡相关疾病的中、重度OSAS患者50例,分为残余嗜睡组(26例)和无残余嗜睡的对照组(24例).2组患者均先后接受自动CPAP治疗1个月和ASV治疗1周.分别比较2组患者治疗前、自动CPAP治疗时及ASV治疗时睡眠期的中枢性睡眠呼吸暂停指数(central sleep apnea index,CSAI),微觉醒指数(micro-arousal index,MAI)等多导睡眠监测参数及白天Epworth嗜睡评分(ESS),采用酶联免疫吸附试验测定肿瘤坏死因子a(tumor necrosis factor-a,TNF-a).两组间比较采用t检验,组内比较使用单因素方差分析,组内3个阶段两两比较采用q检验,两变量相关分析采用Pearson相关检验. 结果 治疗前2组呼吸暂停低通气指数(apnea hypoapnea index,AHI)、MAI、最低SpO2、ESS评分及血浆TNF-a水平组间比较差异没有统计学意义(t值分别为0.630、1.223、0.691、0.764和0.192,均P>0.05),但残余嗜睡组患者的CSAJ(14.39±4.21)次/h显著高于对照组[(8.58±5.75)次/h,t=4.097,P＜0.05].自动CPAP治疗1个月时2组的AHI、CSM、MAI和ESS评分均明显低于治疗前(g值为0.87～112.55,均P.＜0.05),但残余嗜睡组CSAI、MAI及ESS评分明显高于对照组[CSM:(7.19±1.75)次/h,(3.37±1.04)次/h,t=9.473,P＜O.05;MAI:(9.00±1.95)次/h,(2.36 4-0.66)次/h,f=14.385,P＜0.05;ESS:(9.54 4-0.51)分,(5.42±1.32)分,t=2.857,P＜0.05].ASV治疗时残余嗜睡组与对照组的CSAI、MAI及白天ESS评分均进一步下降,尤以残余嗜睡组的下降更为明显.此外残余嗜睡组内血浆TNF-a水平与治疗前(17.2±3.3)残余嗜睡,μg/L相比,自动CPAP治疗时(16.5 4-3.6)μg/L无明显下降(q值为11.696,P>0.05),但在ASV治疗时(12.6±3.4)μg/L与治疗前相比显著降低(q值为11.696,P＜0.05).血浆TNF-a水平与ESS评分呈显著正线性相关(r=0.503,P＜0.01),与MAI亦呈显著正相关(r=0.545,P＜0.01). 结论 经自动CPAP治疗后OSAS患者的残余嗜睡与治疗前、中存在的CSA事件频率有关.ASV在显著降低CSAI的同时也明显改善了提示ASV可有效治疗OSAS患者的残余嗜睡.TNF-a也与残余嗜睡患者的嗜睡程度相关,可能参与了残余嗜睡的发生.     

CPAP治疗OSAHS合并脑卒中的临床研究

目的探讨持续气道正压通气(CPAP)对阻塞性唾眠呼吸暂停低通气综合征(OSAHS)合并脑卒中患者睡眠呼吸状况、认知功能及氧化应激反应的影响。方法将82例OSAHS合并脑卒中患者随机分为研究组(n=41)和对照组(n=41),对照组行常规治疗,研究组加CPAP治疗,均持续治疗12周。比较两组睡眠呼吸指标(ESS、PSQI评分及AHI、LSaO_2)、认知功能指标(LOTCA、MoCA评分)及氧化应激因子(SOD、TAOC、MDA、OX-LDL)水平。结果两组睡眠呼吸指标、认知功能指标、氧化应激因子的时点效应、组间效应、交互效应,差异均有统计学意义(P0.05)。治疗6周、12周,研究组ESS、PSQI评分及AHI、MDA、OX-LDL水平均低于对照组,LOTCA、MoCA评分及LSaO_2、SOD、TAOC水平均高于对照组,差异均有统计学意义(P0.05)。结论 CPAP可明显改善OSAHS合并脑卒中患者睡眠呼吸状况及认知功能,减轻氧化应激反应,应积极行CPAP干预,以改善预后。     

阻塞性睡眠呼吸暂停综合征与高血压的相关性分析

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)与其所导致高血压的相关性。方法对白天嗜睡、打鼾和憋气为主诉的门诊或住院患者行多导睡眠图(PSG)监测,且血压增高达诊断标准患者为研究对象。对睡眠检测结果中的呼吸暂停和低通气指数(AHI)、夜间最低血氧饱和度(SaO2)及睡前、晨起、治疗后的血压进行分析。结果OSAS患者晨起血压较睡前血压增高(P<0.001),并与SaO2呈负相关(P<0.05);SaO2与AHI呈负相关(P<0.05)。体重指数与SaO2呈负相关(P<0.05)与晨起舒张压呈正相关(P<0.05)。经持续气道正压通气(CPAP)治疗、纠正睡眠呼吸暂停6~8周后,晨起血压较治疗前明显下降(P<0.001)。结论OSAS患者肥胖及反复睡眠呼吸暂停与其高血压具有相关性,因此OSAS高血压是一种继发性高血压,CPAP治疗对这种高血压有效。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.