阻塞性睡眠呼吸暂停综合征患者手术治疗的麻醉研究

目的：探讨阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome，OSAS)患者手术治疗的麻醉处理。方法：72例OSAS患者手术前先正压通气治疗(continue positive airway pressure，CPAP)和评价上气道，55例患者经鼻或经口气管插管全身麻醉；在手术完毕患者完全清醒后拔除插管。结果：72例患者中，轻度16例、中度24例、重度32例。合并晨起高血压28例，心电图均有不同程度心肌缺血的表现；红细胞增多症12例；腭咽平面Ⅰ级9例、Ⅱ级24例、Ⅲ级的27例、Ⅳ级12例。术前3．5d行自动调压正压通气治疗(Auto—CPAP)，经口气管内插管48例，经鼻气管内插管6例，均无术中插管困难和术后高血压危象，呼吸道梗阻发生。结论：充分认识OSAHS患者全身麻醉的手术风险，术前CPAP治疗和上气道评估，术中正确处理、严格掌握气管内插管、术后拔管的时机，是保证OSAHS患者手术成功、麻醉安全的关键。     

阻塞性睡眠呼吸暂停综合征患者肾功能和心钠素的变化分析

目的探讨病人肾功能、心钠素(ANP)的含量变化及经鼻持续气道正压(nCPAP)治疗对阻塞性睡眠呼吸暂停综合征(OSAS)患者的影响。方法选择经多导睡眠图(PSG)确诊为中、重度的OSAS患者11例为试验组,PSG检查正常者14例为对照组，试验组给予nCPAP治疗，分别测定其血尿肌酐、尿量、尿β2-微球蛋白(β2-MG)、血浆心钠素(ANP)，并计算出内生肌酐清除率(Ccr)，比较试验组与对照组及试验组治疗前后各项指标的差异。结果试验组与对照组比较，Ccr,尿β2-MG差异无显著性，经nCPAP治疗后两指标也无明显改变；试验组的夜尿量、血ANP含量显著高于对照组，nCPAP治疗后上述指标均较治疗前明显下降。结论OSAS患者夜尿量增多可能与ANP增加有关，这种增高可以被nCPAP治疗所纠正。     

健康教育对改善失眠症患者睡眠质量影响的研究

目的探讨健康教育在改善社区失眠症患者睡眠质量中的作用。方法将在北京某社区卫生服务站就诊的100例失眠症患者随机分为实验组和对照组,每组50例。分别两组患者进行健康教育和常规治疗。健康教育包括改变失眠症患者对睡眠的不正确认识和态度,培养良好的睡眠习惯。6个月后对两组人员进行睡眠状况评价。结果失眠症的发病原因是经济压力、学习工作压力为主。两组患者健康教育后匹兹堡睡眠质量指数各因子分及总分比较有显著性差异（P〈0.05,P〈0.01）。实验组睡眠状况明显改善的为80%,对照组睡眠状况明显改善的为8%,有显著性差异（P〈0.01）。结论健康教育可以改善失眠症患者的睡眠状况,提高睡眠质量。     

阻塞性睡眠呼吸暂停患者临床表现与上气道阻塞部位关系的探讨

目的 观察一组AHI接近的阻塞性睡眠呼吸暂停综合征（OSAS）患者中上气道阻塞部位对多导睡眠监测（PSG）图及临床表现的影响。方法选取36例AHI为30—40的成年男性OSAS患者行再次整夜PSG，加同步上气道及食道压力监测确定上气道最低阻塞部位。比较上气道最低阻塞部位在软腭水平、舌根水平和下咽水平的不同患者中PSG相关参数：平均SaO2、最低SaO2、最长阻塞性呼吸暂停事件时间、呼吸暂停事件中SaO2下降率（dSaO2／dt）、微觉醒指数；以及部分临床表现参数：白日嗜睡程度、入睡前收缩压／清晨收缩压、入睡前舒张压／清晨舒张压以及高血压发生率。结果平均SaO2、最长阻塞性呼吸暂停事件时间和入睡前收缩压／清晨收缩压比值在3种不同上气道最低阻塞部位患者中差异无显著性（P〉0．05），但与软腭水平相比，舌根水平和下咽水平的最低Sa02降低（P〉0．05），dSaO2／dt（％／s）比值增高（P〈0．05），微觉醒指数及白日嗜睡评分增高（P〈0．01），入睡前舒张压／清晨舒张压比值降低（P〈0．05），最低SaO2〈80％的发生率增高（P〈0．01）以及高血压的发生率增高（P〈0．01）。结论AHI接近的OSAS患者上气道阻塞部位在舌根水平以下者与软腭以上水平者相比，阻塞性呼吸暂停事件的致缺氧效率和程度提高，OSAS的临床表现加重。     

Nocturnal sleep in huntington's disease

Summary Nocturnal sleep was studied in 16 inpatients with Huntington's disease. In comparison with healthy controls, patients exhibited a disturbed sleep pattern with increased sleep onset latency, reduced sleep efficiency, frequent nocturnal awakenings, more time spent awake and less slow wave sleep. These abnormalities correlated in part with duration of illness, severity of clinical symptoms, and degree of atrophy of the caudate nucleus. Patients showed an increased density of sleep spindles.     

Pressure stability of nasal CPAP and bilevel devices

Summary Question of the study   Nasal continuous positive airway pressure (CPAP) prevents collapse of the upper airway during sleep in patients with obstructive sleep apnea provided that a positive transmural pressure can be maintained during inspiration. We examined pressure-flow characteristics in seven CPAP and bilevel devices during spontaneous breathing.
Methods   The CPAP devices were set to a pressure level of 9.8  hPa (10  cm H₂O) and adapted to a pneumotachograph using a standard CPAP hose and an outlet valve. We continuously measured flow, volume and pressure during resting ventilation and increasing voluntary hyperventilation and analysed the dependence of the variables on a breath-to-breath basis.
Results   Mean CPAP pressures differed between the devices (9.9 – 10.6  hPa) despite the same settings. In all machines pressure fell during inspiration to 8.4 – 9.8  hPa and increased during expiration to 11.1 – 11.7  hPa. This effect increased with higher flow rates. Maximum expiratory pressures rose to 12 – 19  hPa at peak flow rates of 2 l/s, mean expiratory pressures to 9.5 – 16  hPa. Inspiratory pressures dropped to 8.5 – 4.5  hPa (minimum) and 10.5 – 6.0 (mean). Bilevel devices showed a higher stability than CPAP devices. Pressure swings during the respiratory cycle increased the additional work of breathing.
Conclusions   Due to differences in mean and effective CPAP levels CPAP devices are not simply exchangeable but should be individually adapted. Patients with higher minute ventilation might benefit from more stable CPAP machines. The impact on patients' compliance remains to be evaluated.     

230例打鼾患者多导睡眠图分析

目的　探讨多导睡眠图 (PSG)对睡眠呼吸暂停综合征 (SAS)的诊断价值及睡眠呼吸暂停综合征 (SAS)对睡眠结构、血氧、心血管系统的影响。方法　对 2 30例打鼾患者进行多导睡眠图监测。结果　 2 30例诊断SAS10 8例 (46 9% ) ,单纯鼾症 (SS) 12 2例 ,SAS与SS组两组相比在睡眠结构、呼吸紊乱、血氧、心血管系统变化等差异有显著性。结论　PSG是诊断SAS、判定病情程度、指导治疗的一种良好方法     

Caffeine and light effects on nighttime melatonin and temperature levels in sleep-deprived humans

The effects of caffeine ingestion and exposure to bright light, both separately and in combination, on salivary melatonin and tympanic temperature were assessed in humans. Four treatments during a 45.5 h sleep deprivation period were compared: Dim Light-Placebo, Dim Light-Caffeine, Bright Light-Placebo and Bright-Light Caffeine. The Dim Light-Caffeine condition (200 mg twice each night) relative to the Dim Light-Placebo condition suppressed nighttime melatonin levels and attenuated the normal decrease in temperature. Combining caffeine ingestion with bright light exposure (≥2000 lux) suppressed melatonin and attenuated the normal nighttime drop in temperature to a larger degree than either condition alone; i.e. effects were additive. Circadian effects were also observed in that the amplitude and phase of the temperature rhythm were altered during treatment. These findings establish that the human melatonin system is responsive to caffeine. Other evidence suggests that caffeine may influence melatonin and temperature levels through antagonism of the neuromodulator adenosine.     

悬雍垂保留在悬雍垂腭咽成形术中的作用

目的 探讨悬雍垂保留在悬雍垂腭咽成形术(UPPP)中的作用。方法 比较43例UPPP与43例保留悬雍垂的改良UPPP的术中术后并发症、术后症状改善程度以及术后咽腔测量结果。结果 术中术后大出血、开放性鼻音、进流食返呛人鼻腔等并发症：改良UPPP明显低于UPPP(P＜0．05)；咽异物感：改良UPPP极明显低于UPPP(P＜0．01)。术后1年患者主观症状改善程度：明显改善者，改良UPPP高于UPPP，无改善者，UPPP高于改良UPPP，有显著性差异(P＜0.05)。术后1年咽腔扩大程度：下腭咽横径、前后径，改良UPPP较UPPP两者均明显扩大(P＜0.05)。结论 UPPP中保留悬雍垂可明显降低术中术后大出血、开放性鼻音、进流食返呛人鼻腔、咽异物感等并发症，术后症状明显改善，咽腔得到明显扩大。