纳络酮治疗新生儿呼吸暂停疗效观察

应用纳络酮治疗新生儿呼吸暂停92例,并以氨茶碱治疗新生儿呼吸暂停80例做对照.结果显示纳络酮治疗新生儿呼吸暂停其用药时间和呼吸暂停消失天数均低于对照组.经统计学处理,差异显著(P＜0.05),说明纳络酮治疗新生儿呼吸暂停疗效显著、安全、简单,不需进行血药浓度监测,目前尚未发现明显的副作用.     

鼻塞持续气道正压通气预防极低出生体重儿原发性呼吸暂停30例

目的了解鼻塞持续气道正压通气(NCPAP)预防极低出生体重儿原发性呼吸暂停疗效。方法回顾性分析我院新生儿科2000~2005年收治的30例极低出生体重儿。结果30例患儿中2例28周患儿应用NCPAP治疗失败,合并严重的频发呼吸暂停,改用呼吸机辅助呼吸,最后家人放弃抢救死亡。余28例未使用呼吸机,均治愈出院。结论鼻塞持续气道正压通气是预防极低出生体重儿原发性呼吸暂停的有效方法。     

新型鼻塞持续气道正压呼吸治疗新生儿呼吸窘迫综合征临床观察

目的观察新型鼻塞持续气道正压呼吸（CPAP）治疗新生儿呼吸窘迫综合征的疗效。方法将42例新生儿呼吸窘迫综合征（NRDS）分为2组，新型鼻塞CPAP组（nCPAP）26倒，采用新型鼻基CPAP仪（Infant flow CPAP，VIASYS Heahhcare美国）治疗，水封瓶CPAP组（bCPAP）16例，比较分析2组病例的临床疗效．结果nCPAP组治疗成功率为84，62％（bCPAP组为43．75％），治疗失败率为15．38％（bCPAP组为56．25％），治愈率为76．92％（bCPAP组为37，5％），病死率为3．85％（bCPAP组为18．75％），两组比较差异均有显著意义。结论新型鼻塞CPAP比简易水封瓶CPAP具有疗效好、不良反应少等明显优点。     

阻塞性睡眠呼吸暂停低通气综合征临床治疗分析

目的：探讨综合治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）治疗的效果。方法：对120例OSAHS病人随机平均分为3组，综合组采用上气道狭窄部位手术加经鼻气道持续正压通气、减肥等行为疗法进行综合治疗，手术组采用上气道狭窄部位手术治疗，通气组采用单纯经鼻气道持续正压通气（NCPAP）治疗。以治疗前后睡眠紊乱指数（AHI）和最低血氧饱和度（ISaO2）等作为疗效判定指标，对比观察3组疗效。结果：综合治疗组有效率87．5％；手术组有效率62．5％；通气组有效率65％。经统计学处理，综合治疗组疗效显著优于手术组和通气组（P〈0．01）。结论：采用手术解除上气道狭窄病变，配合经鼻持续正压通气、减肥等综合治疗OSAHS，可显著提高治疗效果。     

呼吸机鼻塞持续气道正压呼吸治疗新生儿肺透明膜病临床观察

目的观察改良的呼吸机鼻塞法持续气道正压呼吸(CPAP)治疗新生儿肺透明膜病的疗效和不良反应。方法将传统的简易鼻塞CPAP方法进行改良,接水封瓶一端导管夹闭,另一端接呼吸机。改良CPAP组30例为治疗组,简易CPAP组25例为对照组,比较分析两组病例的临床资料。结果治疗组总有效率为93.33%,对照组总有效率为68.00%,两组比较有显著性差异。结论呼吸机鼻塞CPAP比传统的简易CPAP具有疗效好,不良反应少等优点。     

纳洛酮联合氨茶碱治疗早产儿呼吸暂停的疗效观察

目的探讨早产儿呼吸暂停行纳洛酮联合氨茶碱治疗的临床疗效。方法将我院2012年12月~2013年12月接收的50例呼吸暂停早产儿随机分为观察组与对照组各25例,对照组行氨茶碱治疗,观察组施加纳洛酮治疗,对比两组患儿的临床疗效。结果两组患儿经治疗后,对照组治疗总有效率以72.0%明显不及观察组的96.0%,组间比较差异显著,有统计学意义(P<0.05)。结论早产儿呼吸暂停行纳洛酮联合氨茶碱治疗后,可有效改善患儿的临床症状,效果显著,值得推广。     

持续气道正压通气治疗新生儿呼吸困难临床观察

目的：探讨分析持续气道正压通气治疗新生儿呼吸困难的临床疗效。方法抽取在2010年5月~2013年12月我院收治的100例新生儿呼吸困难患者,将他们随即的分成研究组和对照组。研究组患者使用持续气道正压通气治疗,对照组患者使用头罩吸氧及药物辅助治疗,比较两组患者的治疗时间、不良反应的发生率情况以及血气分析结果。结果研究组患者的治疗时间显著低于对照组,研究组50例患者中发生不良反应的有6例,占12%,对照组50例患者中发生不良反应的有13例,占26%,研究组患者不良反应的发生率显著低于对照组,两组患者治疗后的血气分析结果较治疗前相比有明显改善,差异均具有统计学意义(P<0.05)。结论采用持续气道正压通气治疗新生儿呼吸困难具有显著的临床疗效,不良反应少,值得推广使用。     

CPAP联合肺表面活性物质治疗对新生儿呼吸窘迫综合征的疗效

目的 研究持续气道正压通气(CPAP)联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)疗效及对患儿血气指标和血清磷酸肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)、方法选择本院2017年8月至2020年10月诊治的105例NRDS患儿,通过随机数表法进行分组,其中对照组(52例)给予CPAP治疗,研究组(53例)给予CPAP联合PS治疗.比较两组患儿治疗前后血气指标、肺表面活性蛋白A(SPA)、甲状腺激素、脑炎症因子和血清CK-MB、BNP、Cys C水平,并统计其并发症.结果 治疗前两组患儿血气指标、SPA、甲状腺激素以及炎症因子水平比较差异无统计学意义(P>0.05),治疗后研究组患儿氧合指数(OI)、氧气分压(PaO2)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、白细胞介素-4(IL-4)水平高于对照组,二氧化碳分压(PaCO2)、SPA、γ-干扰素(INF-γ)水平低于对照组(P<0.05),促甲状腺素(TSH)水平两组比较差异无统计学意义(P>0.05);治疗前两组患儿血清CK-MB、BNP、Cys C水平比较差异无统计学意义(P>0.05),治疗后研究组患儿上述指标水平明显降低且低于对照组(P<0.05);两组患儿并发症发生率比较差异无统计学意义(P>0.05).结论 CPAP联合PS应用于NRDS可调节甲状腺激素水平以及血清CK-MB、BNP、Cys C水平,减轻炎症反应,改善血气指标.     

新型鼻塞持续气道正压治疗新生儿低氧血症疗效分析

目的回顾性的研究新型鼻塞持续气道正压(nCPAP)治疗新生儿严重低氧血症的疗效及安全性。方法以常规给氧无效的83例严重低氧血症患儿为研究对象,其中足月儿32例,早产儿51例。呼吸暂停33例,肺炎并呼吸衰竭(呼衰)21例,肺透明膜病19例,胎粪吸入综合征6例,新生儿湿肺4例。给予使用新型nCPAP治疗,观察治疗效果、并发症发生情况。结果给予nCPAP治疗后绝大多数患儿缺氧状态得到改善。治愈67例,16例效果不好转为气管插管行其他模式机械通气治疗。腹胀8例,心功能不全5例,鼻前庭皮肤部压迫伤2例,无一例发生气漏、慢性肺疾病和早产儿视网膜病。结论新型nCPAP治疗新生儿严重低氧血症操作方便,疗效满意,可以很好的控制温度和吸入氧的浓度,避免了因吸入纯氧、高浓度氧引起的视网膜病、慢性肺疾病等氧中毒性损伤。减少了气管插管的机会,降低了呼吸机相关性肺炎的发生率,相对比较安全。     

纳洛酮和氨茶碱联合治疗极低出生体重儿呼吸暂停

目的观察氨茶碱、纳洛酮联合治疗极低出生体重儿(VLBWI)呼吸暂停的临床效果。方法对2000年1月～2008年7月的156例极低出生体重儿随机分为两组,治疗组88例在应用氨茶城的基础上加用纳洛酮,对照组68例单用氨茶城。结果治疗组显效率69.32%,总有效率88.64%,对照组显效率48.53%,总有效率70.59%;P0.01,差异均具有统计学意义。结论氨茶城和纳洛酮联合治疗极低出生体重儿呼吸哲停比单用氮茶碱效果好,值得临床推广。     

新生儿呼吸暂停临床分析与探讨

目的探讨新生儿呼吸暂停的临床特点。方法对我院儿内科2000年10月～2006年11月收治的156例新生儿呼吸暂停患儿进行回顾性分析。结果本组早产儿发生呼吸暂停114例,足月儿和过期产儿发生呼吸暂停42例,早产儿占73.1%,足月儿和过期产儿占26.9%。体重〈1500g的早产儿发生呼吸暂停明显增高。早产儿发生呼吸暂停每天10次以上的病例数明显多于足月儿和过期产儿。早产儿发生呼吸暂停持续3天以上的病例数明显多于足月儿和过期产儿。早产儿在发生继发性呼吸暂停中,出生后0～7天早产儿由于非感染因素发生呼吸暂停明显高于由于感染因素发生呼吸暂停,出生后≥8天早产儿由于感染因素发生呼吸暂停明显高于由于非感染因素发生呼吸暂停。结论对发生呼吸暂停的新生儿特别是早产儿应作重点监护,及时治疗,以降低死亡率,避免后遗症的发生。     

新生儿硬肿症病因中产科因素的分析

本文分析３２例新生儿硬肿症均为早产儿，提出此症的病因除传统认为与早产、感染及寒冷损伤有关外，３０例（９３．８％）伴有孕母产科异常，如胎膜早破、妊娠高血压综合征、胎儿窘迫、胎位异常、吸引产、胎盘早剥及孕母合并贫血、心脏病等。故提出加强产儿科合作，减少或避免早产，在孕母有上述高危因素时提高预见性，对减少新生儿硬肿症的发生有重要意义。     

Ventilation induced apnea and its effect on dorsal brainstem inspiratory neurones in the rat

The purpose of this study was to examine the effect of mechanical ventilation (MV) on inherent breathing and on dorsal brainstem nucleus tractus solitarius (NTS) respiratory cell function. In pentobarbitone-anaesthetised rats, application of MV at combined high frequencies and volumes (representing threshold levels) produced apnea. The apnea persisted as long as MV was maintained at or above the threshold frequency and volume. Following removal of MV, inherent breathing did not resume immediately, with the diaphragm exhibiting post-mechanical ventilation apnea. The fall in arterial P(CO2) (Pa(CO2)) levels evoked by MV-engendered hyperventilation was shown not to be the trigger for initiation of apnea. MV-induced apnea was immediately reversed by bilateral vagotomy. Further, MV-induced apnea could not be evoked in bilaterally vagotomized animals suggesting that vagal feedback is the critical pathway for its initiation. NTS inspiratory neurones were inhibited during both MV-induced apnea and post-mechanical ventilation apnea, implying the involvement of central neural mechanisms in mediating this effect.     

Gender and age differences in symptoms' profile in sleep apnea syndrome: A possible cause of gender bias in diagnosis

Summary Objective   To compare the age-dependent severity and clinical profile of men and women with polysomnographically-documented obstructive sleep apnea syndrome (OSAS). Method   A retrospective comparison of polysomnographic and clinical data obtained from 358 carefully age- and RDI-matched men and women with OSAS diagnosed in the Technion Sleep Laboratories. Results   We found that women complained significantly more on "difficulties falling asleep", "early morning awakenings", "morning fatigue", "mid-sleep awakenings" and "morning headaches". Nevertheless, stepwise regression analysis revealed that subjective complaints were significant predictors of RDI in men only. Conclusions   We conclude that the clinical profile of OSAS in women is different from that in men, and that these differences should be taken into account when evaluating women suspected of having OSAS.     

Comparison of the effects of continuous positive airway pressure,oral appliance and exercise training in obstructive sleep apnea syndrome

OBJECTIVE:

There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments.

METHODS:

Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392

RESULTS:

After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness.

CONCLUSIONS:

Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.     

Sleep apnea and nocturnal myoclonus in the elderly

—Insomnia, daytime sleepiness, and nocturnal wandering, so common in the elderly, are caused largely by two specific pathophysiologic processes. Sleep apnea is a condition where respiration pauses during sleep, leading to arousal. Sleep apnea is due either to obstruction in the throat or failure of the central respiratory center. Periodic movements in sleep are characterized by frequent ankle and leg flexions, leading to arousal. Sleep apnea and periodic movements in sleep require specific diagnoses and treatments. Each process occurs in 20%–30% of people over 65, and perhaps the majority of older people have one or the other condition or both. Because of possible interactions with these sleep disorders, the widespread prescribing of sleeping pills to elderly patients is irrational and often dangerous. In the future, large-scale clinical trials will be needed to define effective long-term treatments for these conditions and to define when treatment is worthwhile.     

经鼻间歇正压通气治疗新生儿呼吸衰竭的随机对照研究

目的比较经鼻间歇正压通气（nIPPV）与经鼻持续气道正压通气（nCPAP）在新生儿呼吸衰竭中的疗效。方法采用RCT研究的方法,选择2008年1～12月在第三军医大学大坪医院NICU住院的呼吸衰竭新生儿作为研究对象,按随机数字表法将研究对象随机分为nIPPV组和nCPAP组,分别实施nIPPV或nCPAP干预,观察患儿动脉血气分析、应用nIPPV和nCPAP时间、并发症和预后等指标,比较nIPPV组和nCPAP组治疗后需气管插管行机械通气的比例及其预后结局。结果研究期间nIPPV组纳入48例,nCPAP组纳入53例。两组在性别构成比、胎龄、年龄、出生体重、出生后5 m inApgar评分、新生儿急性生理学评分和应用肺表面活性物质比例等方面差异无统计学意义（P均〉0.05）。两组呼吸衰竭原发病分布差异无统计学意义（P〉0.05）。两组治疗前血气分析指标差异均无统计学意义（P均〉0.05）,nIPPV组治疗后1 h血气分析pH和PaO2显著高于nCPAP组（P〈0.05）。nIPPV组治疗成功率为77.1%（37/48例）,nCPAP组为62.3%（33/53例）,nIPPV组显著高于nCPAP组（P〈0.05）。nIPPV组和nCPAP组治疗成功的患儿平均应用nIPPV和nCPAP的时间差异无统计学意义（P均〉0.05）。nIPPV组的预后结局中治愈和好转出院45/48例（93.8%）,nCPAP组为46/53例（86.8%）,两组差异无统计学意义（P〉0.05）。结论与nCPAP相比,nIPPV治疗可显著降低呼吸衰竭新生儿气管插管行机械通气的比例。     

Sleep apnea and nocturnal myoclonus in the elderly

—Insomnia, daytime sleepiness, and nocturnal wandering, so common in the elderly, are caused largely by two specific pathophysiologic processes. Sleep apnea is a condition where respiration pauses during sleep, leading to arousal. Sleep apnea is due either to obstruction in the throat or failure of the central respiratory center. Periodic movements in sleep are characterized by frequent ankle and leg flexions, leading to arousal. Sleep apnea and periodic movements in sleep require specific diagnoses and treatments. Each process occurs in 20%–30% of people over 65, and perhaps the majority of older people have one or the other condition or both. Because of possible interactions with these sleep disorders, the widespread prescribing of sleeping pills to elderly patients is irrational and often dangerous. In the future, large-scale clinical trials will be needed to define effective long-term treatments for these conditions and to define when treatment is worthwhile.     

Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy

OBJECTIVE:

Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy.

METHODS:

Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46±15 years; body mass index, 26.6±4.9 kg/m²) were included, and obstructive sleep apnea (respiratory disturbance index ≥15 events/h) was present in 37 patients (41%).

RESULTS:

Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age ≥45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47–13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43–20.12; p = 0.013].

CONCLUSION:

Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation.