Schlafbezogene Atmungsstörungen bei Parkinsonsyndromen: Häufigkeit, Art und Behandlungsansätze

Objective

In recent literature the contribution of sleep related breathing disorders [SRBD] to the complex sleep disorder of Parkinson's disease [PD] patients is controversely discussed. In our study we discovered the frequency and kind of SRBD in a group of PD patients with sleep complaints.

Patients and methods

83 patients with different types of parkinsonism were studied polysomnographically. Respiration was measured by means of inductance plethysmography, capnography, and pulse oximetry. Different analysing techniques were used. Besides the evaluation of apneas and hypopneas a visual classification of the respiratory pattern and a breath-to-breath calculation of the laboured breathing index [LBI] was carried out.

Results

More than 50% of the patients showed sleep disordered breathing. Most of them had upper airway obstructions. Central apnea was observed in 5 cases, three of those suffered from a heart disease. In 25% the SRBD should be treated. The LBI calculation revealed hints for short pharyngeal obstructions in each patient. This parameter turned out to be highly sensitive to detect changes in upper airway mechanics and was therefore considered to be useful in testing dopaminergic influences on respiratory movements.

Conclusion

Disturbances of the extrapyramidal motor system may lead to long lasting obstructive hypoventilation of different clinical importance. Specific measurement techniques should be used to identify these disturbances. The laboured breathing index may be useful to detect dopaminergic deficits in respiratory motion. As more than 50% of severe SRBD patients are not able to handle nCPAP it is necessary to develop pharmacological options. Dopaminergic medication as a possible therapeutical alternative to nCPAP should be tested in further studies.     

The need for standards in recording and analysing respiratory sounds

Respiratory sounds (RSs) recorded from the chest and trachea are nowadays being electronically analysed by many investigators with a view to (i) determining the mechanisms of their production, and (ii) to develop automated diagnostic systems based on RS analysis, that objectively categorise RS as being associated with health or respiratory diseases. However, one problem that hampers this type of research is that almost every RS investigation team uses different equipment, protocols and analysis methods which, to varying degrees, makes inter-investigator results difficult to compare. The review first discusses the many variables involved in RS recording and analysis, and the different approaches used by different investigators, to highlight this problem and its consequences. Secondly, although the review cannot propose immediately acceptable guidelines and standards for RS analysis, it proposes a ‘seed’ set of guidelines that are ‘up for discussion’ between investigators in the field, the final goal being to inject a degree of standardisation in equipment and methods that are acceptable to all involved.     

The respiratory system as an exercise limiting factor in normal sedentary subjects

Summary The present study was undertaken to investigate the respiratory system as an exercise limiting factor. Breathing and cycle endurance (i.e. the time until exhaustion at a given performance level) as well as physical working capacity 170 (i.e. the exercise intensity corresponding to a heart rate of 170 beats -min^–1 on a cycle ergometer) were determined in four healthy sedentary subjects. Subsequently, the subjects trained their respiratory system for 4 weeks by breathing daily about 901 · min^–1 for 30 min. Otherwise they continued their sedentary lifestyle. Immediately after the respiratory training and 18 months later, all performance tests carried out at the beginning of the study were repeated. The respiratory training increased breathing endurance from 4.2 (SD 1.9) min to 15.3 (SD 3.8) min. Cycle endurance was improved from 26.8 (SD 5.9) min to 40.2 (SD 9.2) min whereas physical working capacity 170 remained essentially the same. During the endurance cycling test in the respiratory untrained state, the subjects continuously increased their ventilation up to hyperventilation [ventilation at exhaustion = 96.9 (SD 23.6) 1 · min^–1] while after the respiratory training they reached a respiratory steady-state without hyperventilation [ventilation at exhaustion = 63.3 (SD 14.5) 1 · min^–1]. The absence of this marked hyperventilation was the cause of the impressive increase of cycle endurance in normal sedentary subjects after respiratory training. The effects gained by the respiratory training were completely lost after 18 months. Our results indicated that the respiratory system was an exercise limiting factor during an endurance test in normal sedentary subjects.     

立体定向放射治疗中肺肿瘤和膈肌动度的研究

目的　本实验为解决位于胸腔肿瘤行立体定向放射治疗时随呼吸动度的影响。方法　对 48例肺癌患者肿瘤动度的实际测量 ,得出肺不同部位肿瘤的动度数据 ;通过模拟呼吸动度下肿瘤体积变化和CT扫描方式的研究 ,将不同体积的小球分别在不同CT扫描时间下进行体积测量分析。结果　⑴位于上肺的肿瘤在X、Y方向动度很小 ,为 (0 .2 0± 0 .0 6 )、(0 .2 0± 0 .11)cm ;下肺X、Y方向动度由于受心脏和大动脉搏动影响 ,稍大于上肺为 (0 .31± 0 .10 )、(0 .36± 0 .10 )cm ;但不论肿瘤位于肺的什么部位 ,对Z轴方向影响最大 ;尤以下肺更显著 ,为 (0 .90± 0 .45 )～ (0 .93± 0 .46 )cm ,这主要受膈肌影响。⑵每一层组织CT扫描时间大于或等于一个呼吸周期的话 ,肿瘤信息不会丢失 ,而且三维重建图像包括了各方向的动度 ;如采用螺旋CT快速扫描则三维重建图像不能包括肿瘤的全部动度。结论　肺部肿瘤呼吸动度影响主要是Z轴方向。如果定位时CT扫描 (每一层组织 )所需时间与每个呼吸周期时间一致的话 ,重建肿瘤轮廓完全包括了动度的影响 ,确定大肿瘤体积 (GTV)根本不需加安全边界。而用扫描时间小于呼吸周期的CT(如螺旋CT)则治疗计划重建的三维影像不能反映出肿瘤的全部动度范围     

易筋经托天式结合推拿治疗颈型颈椎病60例

目的了解川东北地区新生儿体格发育、营养状况及性别和年代差异。方法测录2007-2011年新生儿2248例,其中男1198例（53．3％）,女1050例（46．7％）的体重、身高、双顶径、心率和呼吸频率,且计算体表面积,进行性别、年代差异的比较。结果男、女婴的体重分别为（3．247±0．438）和（3．169±0．421）kg,身高分别为（49．427±1．991）和（48．938±2．052）cm,体表面积分别为（0．202±0．016）,（0．198±0．016）m^2,双顶径分别为（9．274±0．286）和（9．208±0．295）cm,四项指标男女相比较,有显著性差异（P〈0．05）,表明男婴的发育明显优于女婴;而男、女婴的心率分别为（136．184±5．894）和（136．005±6．229）次／min,呼吸分别为（33．351±3．976）和（33．486±3．983）次／min,男,女相比较,无性别差异（P〉0．05）;各年代新生儿六项指标相比较无明显差异,表明近五年来孕妇的营养状况对新生儿的发育无明显影响。结论新生儿的体格发育男性显著高于女性,而近五年来各年之间的发育无明显差异。     

高海拔地区健康成人34例膈肌肌力定量化检测

目的：为了探讨健康成人呼吸肌肌力、贮备力及其与海拔的关系。方法：本文应用高分辨多导胃肠功能检测仪,液压灌注定点牵拉法测定跨膈压（Ｐｄｉ）、最大跨膈压（Ｐｄｉｍａｘ）,并与平原地区所得值相比较。结果：昆明地区健康成人Ｐｄｉ为１６．３４±２．８ｍｍＨｇ、Ｐｄｉｍａｘ５８．８９±１８．７４ｍｍＨｇ;结论：不同年龄、不同性别的Ｐｄｉ、Ｐｄｉｍａｘ无显著性差异（Ｐ＞０．０５）;并提示高海拔地区Ｐｄｉｍａｘ高于平原地区。     

有氧运动结合呼吸训练指导对COPD合并衰弱患者肺功能和睡眠质量的影响

目的:探讨有氧运动结合呼吸训练指导对慢性阻塞性肺疾病(COPD)合并衰弱患者肺功能和生命质量的影响.方法:选取2019年2月至2020年12月福建医科大学附属第一医院收治的COPD合并衰弱患者61例为研究对象,采用奇偶数字法将其分为对照组和观察组,对照组30例,每天给予常规健康教育,观察组31例,给予有氧运动结合呼吸训...     

Twin-block与MRC矫治生长高峰期伴口呼吸的骨性Ⅱ类疗效分析

目的:利用Twin-block与MRC对处于生长高峰期且伴口呼吸的骨性Ⅱ类进行治疗,分析对口呼吸的纠正效果和颌面部软硬组织的变化。方法:从2014~2019年采用Twin-block和MRC矫治且记录完整的错[牙合]患者中,按纳入标准随机选择各20例。统计口呼吸被纠正的情况,测量分析治疗前后的头颅侧位片。结果:两组均表现为对口呼吸的纠正效果较好,差异无统计学意义,但MRC组有效率高于Twin-block组。下颌骨均有一定的前移,两组差异无统计学意义。两组治疗后上下前牙唇倾度变化明显,Twin-block组上前牙唇倾度变化大于MRC组,差异有统计学意义(P<0.05)。两组治疗后软组织侧貌更加美观,MRC组Sn-Stms增加,较Twin-block组差异有统计学意义(P<0.05)。结论:在高峰期利用Twin-block和MRC纠正口呼吸习惯及改善面型,效果都是值得肯定的。     

“五联”疗法治疗神经根型颈椎病的临床研究

目的:观察牵引、电针、神灯照射、推拿、导引"五联"综合疗法治疗神经根型颈椎病的临床疗效。方法:将132例神经根型颈椎病患者随机分为观察组和对照组,每组66例。观察组采用牵引、电针、神灯照射、推拿、导引"五联"综合疗法治疗;对照组采用牵引、理疗、神灯照射、体育疗法治疗。两组治疗时间与次数均相同,治疗结束后评定两组疗效。结果:132例病人中,123例完成整个治疗过程,脱失9例。观察组疗效优于对照组(Z=-4.007,P=0.000)。颈肩肢痛缓解的程度,观察组优于对照组(颈肩肢痛程度评分:t=4.097,P=0.000;颈肩肢痛持续时间评分:t=2.131,P=0.035)。颈肩肢痛频度、上肢麻木程度、颈项僵硬程度3项指标治疗前后的变化程度,两组间差异无统计学意义(t=2.804,P=0.060;t=0.858,P=0.393;t=0.844,P=0.401)。观察组患者治疗后各项体征的阳性率均低于治疗前(压顶试验:χ2=107.496,P=0.000;臂丛神经牵拉试验:χ2=111.518,P=0.000;椎旁压痛试验:χ2=103.995,P=0.000);对照组患者治疗后各项体征的阳性率亦均低于治疗前(压顶试验:χ2=67.658,P=0.000;臂丛神经牵拉试验:χ2=76.530,P=0.000;椎旁压痛试验:χ2=58.634,P=0.000)。治疗后两组间比较各项体征的阳性率,差异无统计学意义(压顶试验:χ2=1.207,P=0.272;臂丛神经牵拉试验:χ2=2.506,P=0.113;椎旁压痛试验:χ2=2.918,P=0.088)。结论:"五联"疗法治疗神经根型颈椎病疗效确切,值得临床推广。     

腹式深呼吸训练在胃食管反流病患者中的应用研究

目的 探讨腹式深呼吸训练对胃食管反流病患者消化道症状群和心理症状群的影响。方法 便利选取2017年7月—2018年2月某三级甲等医院消化科门诊的胃食管反流病患者80例,随机分为试验组和对照组,每组各40例。试验组在常规药物治疗和护理基础上,进行腹式深呼吸训练,每日2次,每次15~20 min;对照组接受常规药物治疗和护理,在干预前及干预8周后比较两组结局指标,包括症状积分、抑郁、焦虑、睡眠质量。结果 干预后两组的症状积分、焦虑抑郁评分、匹兹堡睡眠质量指数总分和各维度得分（除催眠药物维度）均显著低于干预前（P<0.01）。干预后试验组的症状积分显著低于对照组（P<0.01）,焦虑抑郁评分、匹兹堡睡眠质量指数总分和各维度得分（除睡眠质量、催眠药物维度）均显著低于对照组（P<0.05）。结论 腹式深呼吸训练能够有效改善胃食管反流病患者消化道症状群和心理症状群。