Dornir CPAP家庭用呼吸机治疗阻塞性睡眠呼吸暂停综合征的临床疗效

目的:观察持续正压通气(CPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)的治疗效果,并结合应用体会提出临床注意事项。方法:应用CPAP呼吸机治疗30例OSAS患者,并使用夜间多导睡眠图判断CPAP治疗OSAS的效果。结果:CPAP治疗压力为6- 12 cmH2O,平均治疗压力10．5±3．4 cmH2O。治疗后患者的各种临床不适基本缓解,精神佳,睡眠时最低SaO2由治疗前的62．3± 6．7％升高至90．1±6．8％(P<0．01),减血氧饱和度由治疗前的31．5±4．2％降至6．0±4．1％(P<0．01);低通气次数由治疗前的 189．7±152．4降至6．4±5．1(P<0．01),阻塞性呼吸暂停次数由治疗前的212．5±134．5降至12．0±4．8(P<0．01);呼吸紊乱指数由治疗前的51．6±21．2降至5．0±3．1(P<0．01)。结论:CPAP的应用明显改善夜间气道阻塞,疗效果显著。应用CPAP时应指导患者正确使用呼吸方法,需在多导睡眠图的检测下确定最佳CPAP治疗压力才能完成。     

阻塞性睡眠呼吸暂停低通气综合征患者对持续气道正压治疗依从性及影响因素

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者对持续气道正压(CPAP)治疗依从性及其影响因素。方法纳入多导睡眠图确诊的重度OSAHS患者91例,年龄(53±11)岁,男/女(72/19),体重指数(BMI)(27.8±3.6)kg/m2,呼吸暂停低通气指数(AHI)(50.9±8.2)次/h,CPAP水平(11.6±2.0)cmH2O。比较应用与弃用CPAP治疗的两组患者的各指标,如年龄、BMI、AHI、CPAP水平、治疗前后的夜间血氧指标、学历、家庭人均月收入、系统合并症、嗜睡情况及应用面罩加湿器的情况,研究CPAP治疗依从性的影响因素。结果重度OSAHS患者在6个月内约47%放弃CPAP治疗。两组患者的年龄、BMI、AHI、CPAP水平、治疗前后的夜间平均血氧饱和度、夜间最低血氧饱和度均无统计学差异(P>0.05);嗜睡、存在系统合并症、家庭人均月收入高于2000元、高中以上学历的OSAHS患者对CPAP治疗依从性好。Logistic回归分析显示,CPAP治疗依从性的影响因素包括:嗜睡、家庭人均月收入及系统合并症,OR值分别为12.9(95%CI2.209～75.338)、3.134(1.048～5.673)和2.438(1.031～1.190)(P均<0.05)。结论伴有嗜睡症状、高收入与出现系统合并症的OSAHS患者对CPAP治疗的依从性好。     

口腔矫治器和持续正压气道通气对于OSAHS患者疗效的Meta分析

目的Meta分析比较口腔矫治器（OA）和持续正压气道通气（CPAP）治疗阻塞睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法计算机检索以下数据库：PubMed,ISI Web of Knowledge,Ovid,EBSCO Dentistry＆Oral Science Source,Cochrane Library,Embase,CBM,CNKI,WanFangData,纳入有关于比较OA和CPAP治疗OSAHS患者疗效的随机对照试验（RCT）。检索时间截止为20154-11月20日。采用RevMan5．2软件进行Meta分析。结果最终纳入18个RCT进行定性分析,其中16个RCT进行定量分析（meta分析）。Meta分析结果显示：CPAP较OA更能有效降低OSAHS患者的睡眠呼吸暂停低通气指数（AHI）,增加中度亚组患者最低动脉血氧饱和度（miniSaO2）（P〈0．05）;平行试验组中度亚组CPAP较OA更能降低ESS评分（P〈0．05）,其余各组ESS评分、miniSa02以及觉醒指数（ARI）、REM％、FOSQ评分相当（P〉0．05）。定性分析结果显示：患者更倾向于OA治疗。结论CPAP较OA更能改善OSAHS患者客观病情程度。但在主观白天嗜睡情况、夜间睡眠状况、生存质量和血压方面,两者无明显差异,其中OA治疗在改善重度患者夜间睡眠状态效果更佳,CPAP治疗改善中度患者夜间睡眠状态效果更佳。患者更倾向于OA治疗。     

持续气道正压通气对合并嗜睡的轻度OSAHS患者的疗效分析

目的:评估持续气道正压通气(continuous positive airway pressure,CPAP)对合并嗜睡的轻度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的症状和生活质量的影响。方法:纳入轻度OSAHS患者74例,以Epworth嗜睡量表(Epworth sleepiness scale,ESS)进行嗜睡评估,ESS≥10分为嗜睡。伴嗜睡者行CPAP治疗,ESS10分者行健康教育治疗。以Quebec睡眠问卷(Quebec sleep questionnaire,QSQ)进行生活质量评估。8周后对所有患者进行随访。结果:CPAP治疗后,轻度OSAHS患者ESS评分明显下降(P0.01),而QSQ评分显著升高(P0.01),说明CPAP治疗能改善轻度OSAHS患者的嗜睡情况和生活质量。结论:轻度OSAHS患者合并有不同程度的嗜睡,并造成生活质量的下降;CPAP能改善轻度OSAHS患者的嗜睡症状及生活质量。     

延续护理在阻塞性睡眠呼吸暂停低通气综合征病人持续气道正压通气治疗中的应用

[目的]观察延续护理在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)病人持续气道正压通气(CPAP)治疗中的应用效果。[方法]将180例OSAHS病人按照随机数字表法分为观察组及对照组各90例,均应用无创CPAP治疗,并实施常规护理,观察组加用延续护理,比较两组病人出院前后临床症状、生活质量变化及CPAP依从性。[结果]两组病人出院后3个月爱泼沃斯嗜睡量表评分(ESS)、呼吸暂停低通气指数(AHI)均显著降低,睡眠效率均显著升高,观察组改善更为明显(P0.05);对照组出院后每天CPAP使用时间逐渐下降(P0.05),观察组出院后每天CPAP使用时间未见明显变化(P0.05);观察组CPAP治疗时间4h使用天数为62.75d±7.69d,显著高于对照组的39.81d±8.40d(P0.05);两组病人出院后3个月魁北克睡眠问卷(QSQ)评分各维度及总分均显著升高,观察组升高更为明显(P0.05)。[结论]延续护理能够有效提高OSAHS病人接受CPAP治疗的依从性,保证每日CPAP治疗时间,对病人临床症状及生活质量的改善具有积极意义。     

肥胖低通气综合征患者嗜睡与血清瘦素水平的关系及气道持续正压通气治疗效果分析

目的 探讨肥胖低通气综合征(OHS)患者嗜睡症状与血清瘦素水平的相关性及气道持续正压通气(CPAP)治疗OHS的作用机制。方法 选取2017年9月至2019年9月在杭州市萧山区第一人民医院确诊的OHS患者28例作为OHS组,阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴肥胖患者32例作为肥胖OSAHS组,OSAHS不伴肥胖患者30例作为非肥胖OSAHS组,单纯肥胖无OSA患者20例作为单纯肥胖组。采用Epworth嗜睡量表(ESS)评估患者嗜睡情况,多导睡眠监测(PSG)记录睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(SaO₂)等参数,测定各组患者的BMI、血清瘦素水平等,使用自动血气分析仪测得动脉血氧分压(PaO₂)、动脉血CO₂分压(PaCO₂)及pH值。比较各组患者的ESS评分、血清瘦素水平、血气分析指标及PSG参数,并进行相关性分析。OHS组患者接受CPAP治疗6个月,比较治疗前后上述指标变化。结果 OHS组患者的PaO₂、PaCO₂、HCO...     

全程护理干预改善OSAHS患者持续正压通气治疗依从性和睡眠质量的效果分析

目的探讨全程护理干预对改善阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者持续气道正压通气(CPAP)治疗依从性的效果。方法 172例OSAHS患者按照随机数字表法分为实验组及对照组,各86例,均接受CPAP治疗。对照组给予常规护理,实验组实施全程护理干预。比较2组治疗依从性和护理满意度,以及干预前后嗜睡程度和睡眠参数改善情况。结果实验组每日、每周CPAP使用时间均显著长于对照组(P0.05)。实验组依从性好者45例(52.3%),对照组为23例(26.7%),差异有统计学意义(P0.05)。干预6个月后,实验组Epworth嗜睡量表(ESS)评分和嗜睡程度显著低于对照组(P0.05)。2组呼吸暂停低通气指数(AHI)、夜间最低动脉血氧饱和度90%的氧减时间比与治疗前相比显著降低,最低血氧饱和度显著升高(P0.05),且实验组较对照组改善更为显著,差异有统计学意义(P0.01)。实验组满意度为81.4%,显著高于对照组的69.8%(P0.05)。结论全程护理干预能够提高OSAHS患者接受CPAP治疗的依从性,改善患者睡眠质量,值得借鉴。     

口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析

目的系统评价口腔矫正器和持续正压气道通气比较治疗轻中度睡眠呼吸暂停低通气综合征（OSAHS）的疗效。方法计算机检索PubMed、EMbase、qheCochraneLibrary、CBM、VIP、WanFangData及CNKI,查找公开发表及未发表的有关口腔矫正器（OA）和持续正压气道通气（CPAP）比较治疗OSAHS疗效的随机对照试验（RCT）,检索时限均为建库至2012年11月30日,并查找相关会议论文文献,文种和发表时间不限。由2位评价者根据纳入与排除标准独立筛选文献,提取资料并评价质量后,采用RevMan5．1软件进行Meta分析,并采用GRADEpro3．6软件评价证据质量。结果最终纳入7个RCT。Meta分析结果湿示：①CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著,其差异具有统计学意义[WMD=9．13,95％CI（8．77,9．50）,P〈0．00001];②OA和CPAP在改善轻中度OSAHS患者主观白天嗜睡方面,差异无统计学意义[WMD=0．00,95％CI（-0．12,O．12）,P=0．97]。结论与OA相比,CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著,但在改善患者主观白天嗜睡方面无显著差异。受纳入研究质量与数量所限,上述结论尚需开展更多高质量RCT加以验证。     

三种量表用于OSAHS患者初筛预测价值的研究

目的 研究Epworth嗜睡量表(ESS)、Calgary睡眠呼吸暂停生活质量指数(SAQLI)及成人用阻塞性睡眠呼吸暂停低通气综合征患者生命质量评估(QOL-OSAHS)三种量表对于阻塞性睡眠呼吸暂停低通气综合征患者的预测价值.方法 通过分析93例研究对象ESS、SAQLI、QOL-OSAHS量表的得分,采用ROC曲线判别分析量表对于OSAHS初筛的预测价值.结果 作为预测OSAHS的量表,ESS(以≥9分为阳性)灵敏度为0.486,特异度为0.870;SAQLI量表(以≤246分为阳性)灵敏度为0.914,特异度为0.522;QOL-OSAHS量表(以≤161分为阳性)灵敏度为0.886,特异度为0522.结论 三种量表对于OSAHS都有中度的预测价值,对于饮酒者使用SAQLI量表进行预测效果更好.     

应用判别分析法对阻塞性睡眠呼吸暂停低通气综合征患者建立筛查模型的研究

目的 采用逐步Fisher判别分析法建立判别函数,为基层护士对阻塞性睡眠呼吸暂停低通气综合征患者(OSAHS)的筛查提供依据.方法 对83例疑似OSAHS患者进行Epworth嗜睡量表(ESS)评分,并了解夜间症状、合并症情况,同时测量BMI及颈围,以整夜多导睡眠图监测(PSG)为金标准确立诊断.将研究对象分为OSAHS组和非OSAHS组,对各指标进行逐步Fisher判别分析,建立筛查指标的判别模型.结果 经逐步Fisher判别分析,10个指标中有2个指标即BMI和夜间睡眠呼吸暂停症状进入判别模型,建立非标准化判别函数为y=(0.132×BMI)+(0.641×夜间睡眠呼吸暂停)-3.861,根据样本加权求得临界值为0,整体回带和交互验证显示,函数预测准确性分别达92.8％和90.4％.结论 夜间睡眠呼吸暂停的症状和BMI等主客观指标联合应用建立判别函数,可以从统计学角度对OSAHS的筛查提供信息.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.