阻塞性睡眠呼吸暂停低通气综合征患者围手术期护理

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者围手术期的护理方法。方法:选择2008年5月～2011年5月我院OSAHS患者85例,均行悬雍垂腭咽成形术(UPPP),将其随机分为观察组43例和对照组42例,两组均做好围手术期护理,观察组术前行持续正压通气治疗(CPAP),对照组未行CPAP治疗,术后均应用多导睡眠监测仪(PSG)监测,观察两组相关监测参数并比较。结果:观察组患者均能耐受CPAP治疗,OSAHS症状明显缓解,观察组患者最长呼吸暂停时间及呼吸暂停低通气指数均显著低于对照组(P<0.05),而最低血氧饱和度显著高于对照组(P<0.05)。结论:UPPP术前应用CPAP治疗OSAHS可显著缓解临床症状,加强围手术期护理可有效降低手术治疗的危险性。     

脑卒中与阻塞性睡眠呼吸暂停综合征

目的:综述阻塞性睡眠呼吸暂停综合征(obstructivesleepapneasyn-drome,OSAS)与脑卒中的关系及其防治。资料来源:应用计算机检索Medline1994-01/2004-08的关于OSAS和脑卒中的文章,检索词“obstructivesleepapnea,stroke,并限定语言种类为English。同时计算机检索万方数据资源系统中国期刊全文数据库1994-01/2004-08的关于OSAS和脑卒中的文章,限定文章语言种类为中文,检索词“阻塞性睡眠呼吸困难,卒中”。资料选择:对资料进行初审,选取有关阻塞性睡眠呼吸困难与脑卒中的文章。纳入标准为①随机对照临床试验(RCT),采用单盲、双盲或非盲法。②非随机对照试验。③前后对照试验研究。④专著中的章节。排除标准:重复性研究。资料提炼:共收集到18篇关于OSAS与脑卒中关系相关文章,其中14篇符合纳入标准。排除的4篇文章为重复性研究。资料综合:对14篇有关OSAS和脑卒中之间关系的文章进行分析,探讨两者之间的内在联系。结论:OSAS的基本特征是长期反复的低氧血症和高碳酸血症,高血压是其发展到一定程度必然出现的并发症,脑卒中的防治不能忽视对OSAS的及早诊断和治疗。     

阻塞性睡眠呼吸暂停综合征患者葡萄糖代谢研究

目的:观察阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者葡萄糖代谢情况.方法:用多导睡眠图检查确诊的重度OSAS患者162例(OSAS组),行口服糖耐量试验检查、空腹胰岛素及C反应蛋白测定,观察空腹血糖受损及糖耐量异常.并选择同期健康体检者50例作为对照组.结果:OSAS组糖尿病、糖耐量异常发病率及C反应蛋白水平明显高于对照组.结论:OSAS患者存在明显的糖代谢紊乱,可能与炎症有关.     

84例阻塞性睡眠呼吸暂停综合征患者麻醉期间的护理

分析了84例阻塞性睡眠呼吸暂停综合征(OSAS)患者的解剖特点及病理生理变化,针对OSAS患者全身麻醉的风险,总结了麻醉期间的护理配合经验,护理配合重点包括:充分了解和评估患者情况,妥善准备必须的物品和药品,密切关注和配合麻醉操作步骤,及时发现和处理患者的异常情况.     

Treatment of obstructive sleep apnea in primary care

Obstructive sleep apnea should be suspected in patients who are overweight snore loudly, and have chronic daytime sleepiness. The diagnosis of sleep apnea may be confirmed by sleep laboratory studies. Patients' symptoms and the frequency of respiratory events on laboratory testing are important factors in determining the severity of disease. In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep. Continuous positive airway pressure (CPAP) is the most consistently effective treatment for clinically significant obstructive sleep apnea. In general, heavier patients with thicker necks require higher pressure settings. As patients age or gain weight, additional pressure may be necessary. Bilevel pressure machines or machines that slowly ramp up the pressure may increase patient acceptance of CPAP therapy. Complications of CPAP use include nasal dryness and congestion, claustrophobia, facial skin abrasions, air leaks, and conjunctivitis. Strategies to improve patient compliance include allowing patients to try a number of masks to find the most comfortable fit, adding humidification, treating nasal disease and, most importantly, providing close follow-up and encouragement. Oral appliances are inconsistently effective in the management of obstructive sleep apnea but may be an option in patients with mild disease who cannot tolerate CPAP. Palatal surgery often decreases snoring but may not reduce the occurrence of sleep apnea. Patients with severe disease and intolerance of CPAP may be candidates for more invasive surgical procedures. Supplemental oxygen and drug therapy may have limited, adjunctive roles in the treatment of obstructive sleep apnea.     

阻塞性睡眠呼吸暂停综合征的CT观察

阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）以睡眠时出现严重打鼾 ,阵发性呼吸暂停为特征。主要病因为上气道狭窄。本文讨论了ＣＴ扫描方法 ,ＯＳＡＳ患者上气道结构的改变及ＣＴ检查上气道的应用价值。１材料和方法２１例ＯＳＡＳ患者根据临床表现 ,测鼾声响度及在呼吸暂停时测血氧饱和度等均符合ＯＳＡＳ诊断标准。其中男１９例 ,女２例。年龄３２～６０岁。有打鼾病史９～２５年。所有患者均超过预测标准体重。１４例正常人 ,其中男７例 ,女７例。年龄２８～４６岁。平均身高１６５±８ ８２ｃｍ ,平均体重６３ ２４±６ ７８ｋｇ。采用Ｓｏ…     

阻塞性睡眠呼吸暂停低通气综合征病人的护理

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主要特点在于频发睡眠呼吸暂停和低通气,引起血氧饱和度(SaO2)下降和频繁觉醒,从而导致日间的不适症状[1]。临床表现为睡眠时鼾声响亮,呼吸困难,醒后头痛、头昏、嗜睡、精神不振。目前,外科手术治疗主要有腭垂腭咽成形术、气管切开术、     

阻塞性睡眠呼吸暂停低通气综合征病人的护理

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的主要特点在于频发睡眠呼吸暂停和低通气，引起血氧饱和度（SaO2）下降和频繁觉醒，从而导致日间的不适症状。临床表现为睡眠时鼾声响亮，呼吸困难，醒后头痛、头昏、嗜睡、精神不振。目前，外科手术治疗主要有腭垂腭咽成形术、气管切开术、上颌/下颌前移术和激光等治疗手段，这些方法各有不同的适应证。     

The overlap syndrome: chronic obstructive pulmonary disease and obstructive sleep apnea

The overlap syndrome defines the relationship between obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), and is a commonly noted but poorly studied disorder. Individuals who have the overlap syndrome have been recognized to have greater risk for pulmonary hypertension, right heart failure, and hypercapnia than patients who have either disorder alone. In patients who have advanced-stage COPD, concomitant OSA likely has significant adverse consequences. The interaction between these two diseases is unclear, however. Further clinical trials of the overlap syndrome are urgently needed.     

Apolipoprotein E polymorphisms and sleep quality in obstructive sleep apnea syndrome

BackgroundThe purpose of this study was to evaluate the influence of polymorphism on sleep parameters of Obstructive Sleep Apnea Syndrome (OSAS) patients.MethodsPatients were genotyped after a full-night polysomnography using the large Epidemiologic Sleep Study of São Paulo population-based sample.ResultsIndividuals who carry the APOE ε2 allele showed longer sleep latency, lower sleep efficiency and higher numbers of arousals/hour, when compared to ε3 allele homozygous and carriers of ε4 allele (p < 0.05). These findings remained significant even after correction for potential confounders, such as sex, age and African genetic ancestry.ConclusionThe APOE polymorphisms may modulate the effects of intermittent hypoxia and sleep fragmentation in the sleep architecture of OSAS patients, and that the presence of the ε2 allele may serve as a biological marker for the identification of a subgroup of patients who are more likely to suffer with OSAS detrimental effects on sleep, impacting not only the daily functioning, but also their quality of life.     

上下颌骨前移术治疗阻塞性睡眠呼吸暂停低通气综合征病人的护理

阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hyponea syndrome，OSAHS）是指睡眠时上气道塌陷阻塞引起的呼吸暂停和通气不足，伴有打鼾、睡眠结构紊乱、频繁发生血氧饱和度下降及白天嗜睡等病症。由于病因复杂，治疗方案也不同。首先必须通过多导睡眠监测（polysomnography，PSG）作出明确诊断，然后选择合理的手术方案。我科根据病人的阻塞部位、手术难易程度、给病人造成的痛苦及病人的可耐受度等，分三步曲进行治疗。第一阶段：鼻部重建手术、腭垂腭咽成形术、激光、射频；第二阶段：舌根手术、舌骨悬吊术和颏舌肌前移舌骨悬吊术；第三阶段：各类上下颌骨手术。     

上下颌骨前移术治疗阻塞性睡眠呼吸暂停低通气综合征病人的护理

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hyponea syndrome,OSAHS)是指睡眠时上气道塌陷阻塞引起的呼吸暂停和通气不足,伴有打鼾、睡眠结构紊乱、频繁发生血氧饱和度下降及白天嗜睡等病症[1].     

阻塞性睡眠呼吸暂停综合征与高血压的相关性

目的 探讨阻塞性睡眠呼吸暂停综合征(OSAS)与高血压的相关性.方法 按照睡眠资料和24 h血压资料,分为单纯高血压组与合并OSAS高血压组,口服药物治疗4周,比较治疗前后血压变化,OSAS组降压效果差的患者同时接受持续气道正压(CPAP)治疗,观察血压控制情况.结果 30例单纯高血压患者,常规药物降压治疗4周后,血压较治疗前明显下降(P<0.05);OSAS组药物治疗前后无明显变化,再同时用CPAP治疗4周后晨起血压明显下降.结论 合并有OSAS的高血压患者多为难治性,单纯降压药物治疗效果欠佳,需要同时应用CPAP治疗.     

1例剖宫产术后并发阻塞性睡眠呼吸暂停综合征的护理

1病例介绍病人,35岁,孕8产0。妊娠合并甲状腺功能亢进,孕周37周余,阵发性腹痛伴见红4h,急诊入院,因孕妇高龄初产以及珍贵儿,家属及孕妇要求,综合考虑诸多因素后,入院当天下午决定进行剖宫产终止妊娠,完成各项必须化验检查后,进手术室,在生命体征平稳的前提下,在腰麻下行急诊剖宫产术,腰麻镇痛,吗啡0.2mg,穿刺腰3~腰4间隙顺利,试验剂量1mL,麻醉平面为手术开始胸6、术中胸8,术中麻醉平稳。剖宫产一女婴,Apgar评分10分。术后清醒,安返病房,测血压17.3/9.3kPa,心率80/min,呼吸22/min,体温36.8℃。伤口无渗血,恶露量不多,术中失血350mL,补液150…     

阻塞性睡眠呼吸暂停患者主观睡眠质量分析

目的　探讨阻塞性睡眠呼吸暂停综合征 (OSAS)患者的主观睡眠质量及特点。方法　对 2 17例经多导睡眠图 (PSG)检查确诊的OSAS患者进行Pittsburgh睡眠质量指数 (PSQI)调查。结果　根据PSQI评估结果 ,睡眠较差和睡眠很差的病例数均为 88例 (各占 40 .5 % )。PSQI各成分 (I～VII)的计分分别为 1.6± 0 .9,1.1± 1.1,1.1± 1.1,1.4± 1.2 ,0 .8± 0 .6,0 .3± 0 .9,1.9± 1.1分 (P <0 .0 1)。AHI与PSQI及其各成分 (I～VII)间的相关系数分别为 -0 .2 7(P <0 .0 1) ,-0 .15 (P <0 .0 5 ) ,-0 .42 (P <0 .0 1) ,-0 .2 8(P <0 .0 1) ,-0 .17(P <0 .0 5 ) ,-0 .0 8(P >0 .0 5 ) ,-0 .2 1(P <0 .0 1) ,0 .0 8(P >0 .0 5 )。轻、中、重度OSAS3组患者的年龄差异无显著性 ;各组PSQI分别为 9.6± 5 .3 ,8.0± 4.2 ,6.8± 3 .3 (P <0 .0 1) ;各组PSQI的成分II、III、VI计分差异有非常显著性 (P <0 .0 1) ,其它成分计分差异无显著性。结论　OSAS患者睡眠质量差 ,主要表现为白天功能障碍、主观睡眠质量差以及睡眠效率低 ,但患者主观睡眠质量差的程度与OSAS严重程度反而呈弱负相关 ,提示睡眠呼吸暂停本身并不是影响患者主观睡眠质量的主要因素。     

Hypertension and stroke in a young man with obstructive sleep apnea syndrome

In the case reported here, a 34-year-old man with severe obstructive sleep apnea syndrome had arterial hypertension and had had a stroke that caused right hemiplegia. A review of the literature reveals a surprisingly high occurrence of arterial hypertension in subjects with obstructive sleep apnea syndrome, including children. The cause of hypertension in these patients is not clear. Surgical procedures and a new nonsurgical treatment have been successful in relieving the symptoms of obstructive sleep apnea. Our patient's symptoms resolved completely after uvulopalatopharyngoplasty and tonsillectomy. However, his arterial hypertension persisted.     

低温消除等离子体手术治疗阻塞性睡眠呼吸暂停综合征病人的护理

阻塞性睡眠呼吸暂停综合征 (OSAS)简称鼾症 ,是一种潜在的致死性疾病 ,表现为睡眠中出现反复呼吸暂停、低氧血症和睡眠结构紊乱[1] 。近年来推出的低温等离子射频手术装置 ,利用射频能量以非热驱动的过程控制性切除组织以达到组织减容的目的[2 ] ,是治疗OSAS的最新方法 ,现将护理配合介绍如下。1　资料与方法　　选择 2 0 0 4年 1月— 9月在我科住院的 3 8例OSAS病人 ,均排除中枢性因素 ,符合分级标准[3 ] 和诊断标准[4] 。其中男 2 6例 ,女 12例。采用等离子体射频消融腭咽成形术 (CAUP)的治疗方法 ,即将等离子切割和打孔相结合 ,根…