经鼻持续气道正压通气与高压氧治疗对脑梗死合并阻塞性睡眠呼吸暂停低通气综合征的疗效比较

目的 :比较脑梗死合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者应用经鼻持续气道正压通气(nCPAP)治疗与高压氧治疗后对睡眠、神经功能障碍、认知、心理和日常生活能力的疗效。方法:共129例脑梗死合并OSAHS患者入选本研究,随机分为3组。nCPAP组43例(完成21例),高压氧治疗组44例(完成33例),另42例患者为对照组。3组患者在治疗前、后均进行多导睡眠图(PSG)检测及认知、心理、神经功能、日常生活能力评分,并对相关结果进行对比分析。结果:经nCPAP治疗12周后,nCPAP治疗组呼吸暂停低通气指数(AHI)、最低氧饱和度、氧饱和度低于90%的时间百分比等PSG参数较其他2组明显改善(P<0.01);简易精神状态检查(MMSE)量表总评分及记忆、语言项目较其他2组明显改善(P<0.01);复述项目较对照组明显改善(P<0.05)。高压氧治疗组的欧洲脑卒中量表评分较其他2组明显改善(P<0.01),并较对照组在MMSE量表总评分及记忆、语言项目明显改善(P<0.01)。nCPAP治疗组及高压氧治疗组在Barthel指数(BI)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HRSD)评分较对照组明显改善(P<0.01)。结论:脑梗死合并OSAHS患者经nCPAP治疗12周后,其睡眠、认知较其他2组明显改善;高压氧治疗组在神经功能方面较其他2组明显改善;nCPAP治疗组及高压氧治疗组在心理、日常生活能力均明显改善。     

消鼾操联合nCPAP辅助治疗OSAHS并左心室收缩功能不全

将212例阻塞性睡眠呼吸暂停低通气综合征(OSAHS)并左心室收缩功能不全患者随机分为观察组及对照组各106例,两组均予β受体阻滞剂及血管紧张素转换酶抑制剂(ACEI)、地高辛等治疗,观察组在此基础上应用经鼻持续气道正压通气(nCPAP)联合消鼾操治疗.3个月后对两组行多导睡眠(PSG)监测,超声测量左心室收缩末期内径(LVDS)、左心室舒张末期内径(LVDD)及左心室射血分数(INEF).结果观察组呼吸暂停低通气指数(AHI)、平均呼吸暂停时间、整夜睡眠监测中SpO2<90%时间占整个睡眠监测时间的百分比、LVDS、LVDD均明显低于对照组(P<0.05),最低SpO2、LVEF明显高于对照组(P<0.05),夜间平均心率和平均收缩压较治疗前明显降低.认为消鼾操联合nCPAP治疗OSAHS可减少呼吸暂停,纠正低氧血症,降低夜间平均心率和平均收缩压,改善左心室收缩功能,疗效确切.     

经鼻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的远期疗效

经鼻持续气道正压通气 (nCPAP)作为内科治疗阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)的主要方法已被世界各国普遍接受。通过nCPAP治疗 ,可以显著减少以至消除患者睡眠时打鼾、睡眠时呼吸暂停和 (或 )低通气、纠正夜间低氧血症 ,提高睡眠质量、显著改善白天过度嗜睡状态[1 4 ] 。nCPAP治疗OSAHS患者的远期疗效 ,国内报道较少 ,本文总结我院自 1 997年使用nCPAP治疗OSAHS以来 ,能坚持在家长期使用nCPAP治疗 ,定期随访 ,并有完善多导睡眠图 (PSG)监测资料的 6 6例OSAHS患者的远期治疗效果。1　材料与方法1 .1　临床资料　 6 …     

气道正压通气治疗高血压伴阻塞性睡眠呼吸暂停低通气综合征

目的 经鼻持续气道正压通气(nCPAP)治疗高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,以评价该疗法对血压和睡眠呼吸监测参数的影响.方法 临床确诊合并OSAHS的高血压患者,随机分为治疗组和对照组,治疗组在给予常规药物(抗高血压药、抗动脉硬化药物)治疗的同时进行nCPAP治疗,对照组仅给予常规药物治疗.30天后,观察两组治疗前后血压、睡眠呼吸监测参数变化.结果 高血压合并OSAHS患者共60例,治疗组和对照组各30例;治疗后治疗组的收缩压(SBP)、舒张压(DBP)、脉压(PP)、心率(HR)、睡眠呼吸暂停低通气指数(AHI)、最长呼吸暂停时间和最低脉搏容积血氧饱和度(SpO2min),与对照组比较差异有统计学意义(P＜0.05);部分患者降压药物减量或停用,仅用nCPAP治疗就能维持正常血压.结论 nCPAP是非药物治疗合并OSAHS高血压患者的一种安全有效方法.     

3种不同治疗措施对基底节区脑卒中合并阻塞性睡眠呼吸暂停低通气综合征患者的疗效比较

目的:评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并基底节区脑卒中患者应用经鼻持续呼吸道正压通气(nCPAP)和(或)认知康复和(或)基础康复3种不同治疗措施对其睡眠、运动、认知、心理和日常生活能力的疗效。方法:共96例OSAHS合并基底节区脑卒中患者入选本研究,其中27例患者为nCPAP+认知康复组,采用nCPAP+认知康复治疗12周;33例患者为认知康复组,仅采用认知康复治疗;36例患者为对照组。3组患者在治疗前、后均进行多导睡眠图(PSG)监测,进行运动能力及认知、心理、日常生活能力评分,并对相关结果进行对比分析。结果:应用3种不同措施治疗OSAHS合并基底节区脑卒中患者12周后,nCPAP+认知康复组在PSG参数[包括呼吸暂停低通气指数(AHI)、最低氧饱和度、运动功能(FMA)评分、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HRSD)评分较认知康复组及对照组的各项指标明显改善(均P<0.01)。nCPAP+认知康复组及认知康复组在简易精神状态检查(MMSE)量表总评分及地点定向、复述、计算、记忆力、语言项目方面较对照组明显改善(均P     

持续气道正压通气治疗老年人阻塞性睡眠呼吸暂停低通气综合征合并高血压的疗效

目的探讨老年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与高血压之间的关系,以及经鼻持续气道正压通气(nCPAP)治疗老年人OSAHS合并高血压的远期效果。方法104例确诊为OSAHS合并高血压的门诊或住院患者,其中52例患者经过6个月的nCPAP治疗作为治疗组,于行nCPAP治疗前及治疗后6个月,进行多导睡眠图(PSG)及24h动态血压测定,另52例患者未行nCPAP治疗或治疗失败作为对照组,6个月后对两组重复上述各项指标的监测并进行统计学处理。结果治疗组治疗前最长呼吸暂停时间、睡眠呼吸暂停低通气指数(AHI)、最低氧分压(SpO2)、收缩压/舒张压分别为(63.5±22.4)s、(46.8±19.2)次/h、(62.4±18.5)%、(146.2±9.5/90.4±8.5)mmHg,经过nCPAP治疗6个月后,上述各项指标分别为(10.5±11.4)s(、4.6±4.0)次/h(、89.81±8.2)%、(134.7±8.3/82.6±9.1)mmHg,均有显著改善(P<0.01),平均血压明显好转,治疗组降压有效率为96%,与对照组比较差异有统计学意义(P<0.01),部分患者停用降压药。结论反复低氧血症、呼吸暂停可能是部分老年OSAHS伴发高血压的发病原因,nCPAP治疗有助于此类患者血压的恢复。     

经鼻持续气道正压通气对脑梗死合并阻塞性睡眠呼吸暂停低通气综合征患者的疗效评价

目的:评价脑梗死合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者应用经鼻持续气道正压通气(nCPAP)治疗后对认知、心理和日常生活能力的疗效。方法:共96例脑梗死合并OSAHS患者入选本研究,其中42例患者为治疗组,采用nCPAP治疗12周,另54例患者为观察组。2组患者在治疗前后均进行多导睡眠图(PSG)检测、D-二聚体测定及认知、心理、神经功能、日常生活能力评分,并对相关结果进行对比分析。结果:经nCPAP治疗12周后,治疗组在PSG各参数[包括呼吸暂停低通气指数(AHI)、最低氧饱和度、氧饱和度低于90%的时间百分比、觉醒次数、非快速动眼期Ⅰ+Ⅱ期比例、Ⅲ+Ⅳ期比例、快速动眼期比例]的改善较观察组更明显(P<0.05)。简易精神状态检查(MMSE)评分总分较观察组明显改善(P<0.001),其中复述、计算、记忆力、语言各分项目评分有明显改善(P<0.01)。欧洲脑卒中量表评分(P     

气道正压通气治疗高血压伴阻塞性睡眠呼吸暂停低通气综合征

目的经鼻持续气道正压通气(nCPAP)治疗高血压合并阻塞性睡眠呼吸暂停低通气综合征(OS-AHS)患者,以评价该疗法对血压和睡眠呼吸监测参数的影响。方法临床确诊合并OSAHS的高血压患者,随机分为治疗组和对照组,治疗组在给予常规药物(抗高血压药、抗动脉硬化药物)治疗的同时进行nCPAP治疗,对照组仅给予常规药物治疗。30天后,观察两组治疗前后血压、睡眠呼吸监测参数变化。结果高血压合并OSAHS患者共60例,治疗组和对照组各30例;治疗后治疗组的收缩压(SBP)、舒张压(DBP)、脉压(PP)、心率(HR)、睡眠呼吸暂停低通气指数(AHI)、最长呼吸暂停时间和最低脉搏容积血氧饱和度(SpO2min),与对照组比较差异有统计学意义(P<0.05);部分患者降压药物减量或停用,仅用nCPAP治疗就能维持正常血压。结论nCPAP是非药物治疗合并OSAHS高血压患者的一种安全有效方法。     

经鼻持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征患者血清C反应蛋白的影响

经鼻持续气道正压通气(nCPAP)是目前公认的治疗中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)最安全有效的方法。它能明显改善患者睡眠质量,减少夜间呼吸暂停次数,纠正低氧血症,并降低OSAHS患者冠心病的发生率和死亡率[1]。我们的研究测定OSAHS患者血清C反应蛋白(CRP)水平,并观察nCPAP短期治疗(4d)是否降低OSAHS患者血清CRP水平,并进一步探讨OSAHS与冠心病之间可能存在的关系。对象与方法　入选2003年1月～10月在我院睡眠实验室通过多导睡眠图(PSG)确诊的25例OSAHS患者(中度7例、重度18例)和36名对照者。25例OSAHS…     

睡眠实验室阻塞性睡眠呼吸暂停低通气综合征患者首次经鼻持续气道正压治疗的接受性及影响因素

目的调查睡眠实验室阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者首次经鼻持续气道正压(nCPAP)治疗主观接受性及其影响因素。方法选择广西区人民医院广西睡眠呼吸疾病中心经多导睡眠监测仪(PSG)检查确诊OSAHS患者,符合无创气道正压通气治疗适应证者86例,在睡眠实验室进行首次nCPAP治疗后,给予接受性问卷的调查并分析其影响因素。结果 63例患者接受性良好,19例接受性一般,4例接受性差。影响患者接受性的因素主要是治疗时的睡眠状态、治疗后精神状态的改善,夜尿减少;而性别、年龄、治疗前后呼吸暂停低通气指数(AHI)、最低血氧饱和度(SaO_2)、SaO_2低于90%、80%的低氧时间、nCPAP压力水平、治疗前嗜睡评分无明显关系。结论重视OSAHS患者首次治疗的主观感受,有助于提高其接受性和顺应性。     

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.     

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.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.