Airtraq喉镜清醒插管在阻塞性睡眠呼吸暂停综合征中的临床应用

目的:探讨Airtraq喉镜清醒插管在OSAS中的临床应用价值。方法:择期行全麻下UPPP术OSAS患者42例,按随机数字表法分为Airtraq喉镜组和Macintosh喉镜组各21例。麻醉诱导后分别使用Airtraq喉镜和Macintosh喉镜显露声门行清醒气管插管。结果:Airtraq喉镜组总插管时间短于Macintosh喉镜组(P<0.05),插管成功率高于Macintosh喉镜组(P<0.05),IDS评分低于Macintosh喉镜组(P<0.05)。与T1相比,两组T2时SBP、DBP、RPP明显下降(P<0.05),HR变化不明显(P>0.05)。与T2相比,Airtraq喉镜组T3时各血流动力学指标无明显变化(P>0.05),Macintosh喉镜组T3时各血流动力学指标明显升高(P<0.05)。Airtraq喉镜组T3时的HR和RPP明显低于Macintosh喉镜组(P<0.05)。Airtraq喉镜组声门完全显露率(I级)明显高于Macintosh喉镜组(P<0.05)。Macintosh喉镜组发生咽喉损伤1例,咽痛1例,Airtraq喉镜组无1例发生。结论:在OSAS预计困难气道患者中应用Airtraq喉镜清醒插管,操作便捷,插管成功率高,血流动力学反应轻,声门显露好,并发症少,相比Macintosh直接喉镜,具有明显的优势。     

Artificial Apnea Classification with Quantitative Sleep EEG Synchronization

In the present study, both linear and nonlinear EEG synchronization methods so called Coherence Function (CF) and Mutual Information (MI) are performed to obtain high quality signal features in discriminating the Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA) from controls. For this purpose, sleep EEG series recorded from patients and healthy volunteers are classified by using several Feed Forward Neural Network (FFNN) architectures with respect to synchronic activities between C3 and C4 recordings. Among the sleep stages, stage2 is considered in tests. The NN approaches are trained with several numbers of neurons and hidden layers. The results show that the degree of central EEG synchronization during night sleep is closely related to sleep disorders like CSA and OSA. The MI and CF give us cooperatively meaningful information to support clinical findings. Those three groups determined with an expert physician can be classified by addressing two hidden layers with very low absolute error where the average area of CF curves ranged form 0 to 10 Hz and the average MI values are assigned as two features. In a future work, these two features can be combined to create an integrated single feature for error free apnea classification.     

睡眠剥夺和药物诱导睡眠脑电图在癫痫诊断中的应用价值

目的探讨睡眠剥夺和药物诱导睡眠脑电图在癫痫诊断中的作用。方法选择2005年6月-2009年6月在河北省人民医院门诊就诊和住院治疗的清醒间歇期脑电图无阳性发现的癫痫患者243例,分为睡眠剥夺诱导睡眠组和水合氯醛诱导睡眠组,分别进行清醒期和睡眠期脑电图记录。结果睡眠剥夺诱导睡眠组和水合氯醛诱导睡眠组癫痫样放电出现率分别为66．3％和45．6％,差异有统计学意义（P〈0．05）。结论睡眠剥夺和药物诱导睡眠脑电图均可提高脑电图阳性率,前者效果较好,后者较为方便。     

剥夺睡眠—睡眠联合诱发脑电图在癫痫诊断中的应用

目的研究剥夺睡眠-睡眠联合诱发试验在癫痫诊断中的价值及适应症。方法对58例临床诊断为癫痫的患者行常规脑电图(EEG)和剥夺睡眠-睡眠联合诱发EEG检查,并将两种方法进行比较;剥夺睡眠后清醒时EEG描记结果与睡眠时EEG描记结果进行比较。结果剥夺睡眠-睡眠EEG痫样放电检出率比常规EEG痫样放电检出率明显提高,前者为86.2％(50/58),后者为41.4％(24/58),两者比较有极其显著性差异(P<0.001)。剥夺睡眠清醒时EEG与剥夺睡眠后睡眠EEG痫样放电检出率比较,有显著性差异(P<0.05)。剥夺睡眠后睡眠EEG可起补充作用,且很易记录到睡眠EEG。结论剥夺睡眠-睡眠联合诱发EEG对痫样放电的检出率有明显提高,对癫痫 的诊断、治疗有重要意义。     

不同年龄阶段重度阻塞性睡眠呼吸暂停低通气综合征患者睡眠脑电波特征研究

背景　阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种常见的睡眠障碍,既往研究表明,年长患者更容易出现睡眠结构的变化和认知功能下降,其原因尚未完全明确,且目前关于睡眠脑电波（EEG）和睡眠结构与不同年龄阶段OSAHS患者关系的研究较少。目的　探究不同年龄阶段重度OSAHS的EEG特征,旨在进一步为大脑可塑性变化提供重要信息,指导临床治疗。方法　选取2017年6月—2018年3月在北京大学深圳医院睡眠呼吸障碍疾病诊疗中心确诊的67例重度OSAHS患者,依据我国最新的年龄划分标准将其分为年轻组（18~40岁,n=34）和年长组（41~65岁,n=33）。比较两组患者呼吸暂停低通气指数（AHI）、夜间最低血氧饱和度（LSpO2）、睡眠有效率,非快速眼动睡眠（NREM）各分期（N1、N2、N3期）、快速眼动睡眠（REM）期睡眠时间占总睡眠时间百分比,NREM期各波〔δ波（0.5~4.0 Hz）、θ波（4.1~8.0 Hz）、α波（8.1~12.0 Hz）和β波（12.1~30.0 Hz）〕脑电能量密度;并分析两组患者NREM期各波脑电能量密度、REM期睡眠时间、睡眠有效率与AHI的相关性。结果　年长组患者N1期、N2期睡眠时间占总睡眠时间百分比大于年轻组,年长组患者N3期、REM期睡眠时间占总睡眠时间百分比小于年轻组（P<0.05）。年长组患者N1期、N2期、N3期δ波脑电能量密度均低于年轻组（P<0.05）。年长组患者N3期θ波脑电能量密度低于年轻组（P<0.05）。年长组患者N2期、N3期α波脑电能量密度低于年轻组（P<0.05）。年长组患者N1期、N2期、N3期β波脑电能量密度均高于年轻组（P<0.05）。年轻组患者NREM期δ波、θ波、α波脑电能量密度及REM期睡眠时间、睡眠有效率与AHI呈负相关（r值分别为-0.338、-0.315、-0.383、-0.483、-0.501,P值均<0.05）;年轻组患者NREM期β波脑电能量密度与AHI无直线相关关系（P>0.05）。年长组患者NREM期各波脑电能量密度、REM期睡眠时间和睡眠有效率与AHI无直线相关关系（P>0.05）。结论　重度OSAHS的年轻患者与年长患者的EEG存在明显差异,年长患者N1期、N2期睡眠时间较长,而N3、REM期睡眠时间较短;与年轻患者相比,年长患者NREM期的δ波、N3期的θ波和α波均减少,而NREM期的β波却明显增加。这些EEG的改变导致了重度OSAHS的年长患者深睡眠时间减少,而浅睡眠时间增加,外界的刺激及间歇性低氧更容易导致觉醒,直接导致睡眠片段化增加。     

睡眠脑电图在儿童癫痫中的诊断价值及疗效评估

目的:了解儿童癫痫(EP)与睡眠的关系。方法:对98例可疑或临床诊断的儿童EP的睡眠脑电图(EEG)进行分析及临床随访。结果:正常22例,异常76例,异常率77.5%(广泛性异常10例,局限性异常66例)。结论:睡眠EEG可提高儿童EP的阳性率,对其诊断、分型、临床随访具有重要价值。     

Singular Spectrum Analysis of Sleep EEG in Insomnia

In the present study, the Singular Spectrum Analysis (SSA) is applied to sleep EEG segments collected from healthy volunteers and patients diagnosed by either psycho physiological insomnia or paradoxical insomnia. Then, the resulting singular spectra computed for both C3 and C4 recordings are assigned as the features to the Artificial Neural Network (ANN) architectures for EEG classification in diagnose. In tests, singular spectrum of particular sleep stages such as awake, REM, stage1 and stage2, are considered. Three clinical groups are successfully classified by using one hidden layer ANN architecture with respect to their singular spectra. The results show that the SSA can be applied to sleep EEG series to support the clinical findings in insomnia if ten trials are available for the specific sleep stages. In conclusion, the SSA can detect the oscillatory variations on sleep EEG. Therefore, different sleep stages meet different singular spectra. In addition, different healthy conditions generate different singular spectra for each sleep stage. In summary, the SSA can be proposed for EEG discrimination to support the clinical findings for psycho-psychological disorders.     

2种睡眠脑电图诊断小儿癫痫阳性率的比较

目的　对比分析剥夺睡眠脑电图与药物睡眠脑电图诊断小儿癫痫的阳性率。方法　为 98例临床诊断癫痫或疑似癫痫的病人先后进行药物睡眠脑电图和剥夺睡眠脑电图检查。结果　药物睡眠脑电图痫样放电检出率 35 7% ,剥夺睡眠脑电图痫样放电检出率 6 8 4 %。结论　剥夺睡眠脑电图诊断小儿癫痫优于药物睡眠脑电图。     

夜班护士睡眠状况调查及缓解措施

目的了解夜班护士的睡眠情况，探讨睡眠不足对夜班护士的影响及缓解措施。方法采用问卷调查的方法对某三级甲等医院50名上夜班的护士进行调查，并进行对照分析。结果94％的夜班护士感到睡眠不足，100％的人感觉到因夜班引起的睡眠不足对自己的健康有影响。结论睡眠不足与夜班护士的身心健康和工作质量密切相关，应引起护士和护理管理者的高度重视。     

晚期早产儿活动睡眠期脑电图特点

目的探讨晚期早产儿活动睡眠期脑电图特点。方法对75例晚期早产儿脑电图进行回顾性分析。结果晚期早产儿活动睡眠期的脑电图以混合波为主;特征性波形8刷在活动睡眠期34、35周出现次数较多,34周时主要位于枕颞区,枕区最多,35周时均在枕区;一过性尖波大区分出现在额顶区,其中额区最多,枕区及颞区散发,频率主要为4～8Hz,并且随着年龄的增加,波幅逐渐下降。结论晚期早产儿活动睡眠脑电图特点,对临床判断早产JLfl~i功能状态及发育成熟水平提供了一定依据。     

Estimation of Sleep Stages by an Artificial Neural Network Employing EEG, EMG and EOG

Analysis and classification of sleep stages is essential in sleep research. In this particular study, an alternative system which estimates sleep stages of human being through a multi-layer neural network (NN) that simultaneously employs EEG, EMG and EOG. The data were recorded through polisomnography device for 7 h for each subject. These collective variant data were first grouped by an expert physician and the software of polisomnography, and then used for training and testing the proposed Artificial Neural Network (ANN). A good scoring was attained through the trained ANN, so it may be put into use in clinics where lacks of specialist physicians.     

非手术措施救治大面积深度烧伤二例分析

以2例大面积深度烧伤患者治疗情况为例,从(1)创面处理方法的合理选择;(2)正确规范的换药是防止创面感染;(3)SD-Ag乳膏临床应用;(4)创面感染的综合判断等四个方面分析探讨大面积深度烧伤患者治疗经验.     

功能性消化不良患者的睡眠行为及睡眠生理学特征分析

目的探讨功能性消化不良(FD)患者的睡眠行为及睡眠生理学特征。方法47例功能性消化不良患者分别接受了匹兹堡睡眠质量指数问卷(PSQI)、多导睡眠图(PSG)和汉密尔顿抑郁量表(HAMD)评估,并与对照组(健康体检者,23例)进行比较。结果PSQI问卷评估中,两组受试者的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能评分和PSQI总分间差别均有统计学意义(P<0.05)。PSG各项睡眠参数比较中,两组受试者的TSA、REM睡眠潜伏期、REM睡眠时间、睡眠潜伏期(RL)、总觉醒时间(ATA)、睡眠效率(SE)、非快速眼运动睡眠期Ⅰ期百分数(S1)、非快速眼运动睡眠期Ⅲ Ⅳ期百分数(SWS)间差别有统计学意义(P<0.05)。轻、中、重度FD患者的PSQI总分和HAMD总分与对照组比较,差别有统计学意义(P<0.05);重度FD患者的PSQI总分和HAMD总分与轻、中度FD患者比较,差别亦有统计学意义(P<0.05)。结论FD患者有明显的睡眠质量下降和睡眠生理结构异常,后两者表现与FD症状积分和抑郁状态程度有一定相关性。     

Determination of Sleep Stage Separation Ability of Features Extracted from EEG Signals Using Principle Component Analysis

In this study, a method was proposed in order to determine how well features extracted from the EEG signals for the purpose of sleep stage classification separate the sleep stages. The proposed method is based on the principle component analysis known also as the Karhunen–Loéve transform. Features frequently used in the sleep stage classification studies were divided into three main groups: (i) time-domain features, (ii) frequency-domain features, and (iii) hybrid features. That how well features in each group separate the sleep stages was determined by performing extensive simulations and it was seen that the results obtained are in agreement with those available in the literature. Considering the fact that sleep stage classification algorithms consist of two steps, namely feature extraction and classification, it will be possible to tell a priori whether the classification step will provide successful results or not without carrying out its realization thanks to the proposed method.     

Computational Fluid Dynamics Simulation of the Upper Airway of Obstructive Sleep Apnea Syndrome by Muller Maneuver

This study aimed to use computer simulation to describe the fluid dynamic characteristics in patients with obstructive sleep apnea syndrome(OSAS) and to evaluate the difference between during quiet respiration and the Muller maneuver(MM). Seven patients with OSAS were involved to perform computed tomographic(CT) scanning during quiet respiration and the MM. CT data in DICOM format were transformed into an anatomically three-dimensional computational fluid dynamics(CFD) model of the upper airway. The velocity magnitude, relative pressure, and flow distribution were obtained. Numerical simulation of airflow was performed to discuss how the MM affected airflow in the upper airway. To measure the discrepancy, the SPSS19.0 software package was utilized for statistic analysis. The results showed that the shape of the upper airway became narrower, and the pressure decreased during the MM. The minimal cross-sectional area(MCSA) of velopharynx was significantly decreased(P<0.05) and the airflow velocity in MCSAs of velopharynx and glossopharynx significantly accelerated(P<0.05) during the MM. This study demonstrated the possibility of CFD model combined with the MM for understanding pharyngeal aerodynamics in the pathophysiology of OSAS.     

110例癫痫患儿动态脑电图及常规脑电图监测分析

目的：监测癫痫患儿的动态脑电图（AEEG）以及常规脑电图（REEG）并进行分析,探讨其各自的价值,为临床诊断及治疗小儿癫痫提供依据。方法选取我院近1 a 来收治的癫痫患儿110例,进行动态脑电图（AEEG）和常规脑电图（REEG）监测,严格按照仪器监测规则进行监测并准确记录监测结果。结果 AEEG监测异常89例,占80．9％,其中临床发作19例,占17．3％;REEG 监测异常39例,占35．5％,其中临床发作5例,占4.5％。结论 AEEG在监测癫痫症患儿的脑电异常活动方面明显优于REEG,能更好地为临床小儿癫痫的诊断与治疗提供可靠依据。     

间歇性缺氧及睡眠剥夺建立大鼠睡眠呼吸暂停模型

目的建立睡眠呼吸暂停综合征（SAS）大鼠模型。方法选取雄性SD大鼠32只,随机分为4组,分别是常氧正常睡眠对照组,常氧睡眠剥夺组,间歇性低氧正常睡眠组,间歇性低氧睡眠剥夺组,每组8只。实验期间每周测定鼠尾收缩压1次,在缺氧、睡眠剥夺终点测定有创动脉压、心脏重量（CW）,左心室重量（LVW）,并计算出心脏质量指数（CMI）;取大动脉、肺、肾组织石腊包埋,病理切片光镜观察。结果随时间的延长,睡眠剥夺组、间歇性低氧组、间歇性低氧睡眠剥夺组鼠尾压逐步升高,并出现左室重量、心脏重量增加,以间歇性低氧睡眠剥夺组最为明显;组织病理显示低氧睡眠剥夺组大鼠动脉壁不规则增厚,肾小管上皮细胞肿胀,可见蛋白管型;肺小动脉管壁增厚,管腔变窄。结论通过模拟间歇性缺氧及睡眠剥夺机制建立了大鼠睡眠呼吸暂停综合征动物模型。     

阻塞性睡眠呼吸暂停综合征患者中体位性睡眠呼吸暂停者的发生率及特征观察

目的探讨体位性睡眠呼吸暂停(positional sleep apnea,PSA)在阻塞性睡眠呼吸暂停综合征(OSAS)患者中发生率及临床特征。方法选自2004年1月～2010年12月在笔者医院睡眠中心经PSG确诊为OSAS的7879例患者中PSA的总体发生率和轻度(5≤AHI<15)、中度(15≤AHI<30)、重度OSAS(AHI≥30)患者中PSA的各自发生率。分别选择AHI相匹配的PSA患者203例(PSA组)和非PSA患者226例(非PSA组)就年龄、BMI、颈围、腰围、PSG各参数及OSAS的可能病程进行了组间比较。结果 OSAS患者中PSA的总体发生率为16.8%(1326/7879)。但PSA的分别发生率在轻度OSAS患者中为34.2%(942/2754),中度OSAS患者中为11.4%(322/2821),在重度OSAS患者中为2.8%(62/2214)。PSA组与非PSA组比较显示PSA患者较非PSA患者BMI低(24.2±2.8 vs 27.1±2.4,P<0.05),颈围细(37.4±1.7cm vs 39.2±1.9cm,P<0.05),腰围无显著组间差异(92.2±4.3cm vs 94.3±3.7cm,P>0.05),仰卧位睡眠占总睡眠时间比例较高(89.4%±6.3%vs 79.8%±7.7%,P<0.05),OSAS的病程可能较短(3.8±2.4 vs 5.6±2.3,P<0.05),但年龄无组间明显差异(47.2±18.4 vs 49.3±19.1,P>0.05)。结论 PSA在程度较轻的SAS患者中发生率较高。与AHI相似的非PSA患者相比,PSA患者的BMI较低、颈围较细,睡眠期仰卧位时间比较长、OSAS的病程可能较短。     

子宫肌瘤术后下肢深静脉血栓形成的危险因素及预防对策

目的 探讨子宫肌瘤术后下肢深静脉血栓形成(DVT)的危险因素及预防对策.方法 以60例子宫肌瘤患者为对象,记录患者术后下肢DVT发生率,分析其发生下肢DVT的危险因素.结果 60例接受手术治疗的子宫肌瘤患者术后6例(10.00％)发生下肢DVT.其中左下肢3例,右下肢4例,双下肢10例.DVT组与非DVT组在年龄、术前...     

舒芬太尼复合瑞芬太尼在困难气道清醒气管插管中的效果

目的：探讨舒芬太尼与瑞芬太尼复合用药在困难气道清醒插管中应用的安全性和有效性。方法：2009年10月～2010年4月在我院选择困难气道需清醒气管插管患者66例,66例患者随机分为Ⅰ、Ⅱ、Ⅲ3组,在充分表面麻醉后,Ⅰ组（环甲膜穿刺组）环甲膜穿刺并注入2%利多卡因2 ml,而后行插管操作;Ⅱ组（瑞芬太尼组）瑞芬太尼0.75μg/kg的一次剂量后以每分钟0.075μg/kg持续静脉注射;Ⅲ组（舒瑞芬太尼复合组）给予舒芬太尼0.75μg/kg的一次剂量后以瑞芬太尼0.075μg/kg持续静脉注射。记录3组患者在诱导前、插管过程中以及导管进入气管后的心率、血压、血氧饱和度。结果：3组均能够完成气管插管。Ⅲ组的血流动力学变化明显小于前两组,3组差异有统计学意义（P〈0.05）。结论：在表面麻醉基础上,舒芬太尼复合瑞芬太尼能更好的完成困难气道的清醒插管,血流动力学变化更小,更为安全,更为舒适。