重度阻塞性睡眠呼吸暂停低通气综合征围手术期处理对术中及术后出血的影响

目的 探讨对重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS) 患者在围手术期进行正压通气治疗（continue positive airway pressure,CPAP）及血压控制后,术中应用电刀对术中术后出血的影响。方法 应用多导睡眠监测仪和Holter心电及血压检测仪对具有打鼾症状的患者进行监测,将合并高血压的252例OSAHS 患者分为对照组、治疗组。对照组于围手术期常规口服降压药物治疗,不行CPAP 治疗,术中不应用电刀;治疗组围手术期应用CPAP治疗,静滴降压药物,随时控制血压于稳定状态,术中应用电刀。对两组患者术中、术后的出血量进行比较分析。结果 治疗组出血量明显少于对照组（P＜0.01）,差异有统计学意义。结论 围手术期正压通气可以有效改善患者因长期缺氧而导致的机体损害,有利于血压保持正常稳定状态,提高手术耐受力,动态的血压控制和应用电刀可以有效减少术中出血量及术后出血的机会,降低手术危险性,避免严重并发症的发生。     

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders: A brief overview for paediatricians

‘Neurodevelopmental disorders’ comprise a group of congenital or acquired long-term conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations, including autism spectrum disorder, attention deficit/ hyperactivity disorder, tic disorder/ Tourette’s syndrome, developmental language disorders and intellectual disability. Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability. Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm. Together these are referred to as neurodevelopmental, emotional, behavioural, and intellectual disorders (NDEBIDs) in this paper. Varying prevalence rates for NDEBID have been reported in developed countries, up to 15%, based on varying methodologies and definitions. NDEBIDs are commonly managed by either child health paediatricians or child/ adolescent mental health (CAMH) professionals, working within multidisciplinary teams alongside social care, education, allied healthcare practitioners and voluntary sector. Fragmented services are common problems for children and young people with multi-morbidity, and often complicated by sub-threshold diagnoses. Despite repeated reviews, limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research. The recently developed “Mental, Behavioural and Neurodevelopmental disorder” chapter of the International Classification of Diseases-11 offers a way forward. In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID, enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.     

癫痫患者的睡眠障碍

目的：探讨癫痫患者的睡眠障碍。方法：对１０例有睡眠障碍主诉的癫痫病人进行夜间多导生理描记仪（ＰＳＧ）测试,所有病人均在抗痫药物治疗前进行检查。结果：本组病人的ＰＳＧ测试睡眠效率减低,多显示浅睡期延长;２例病人的夜间睡眠障碍与睡眠中周期性肢体活动增多有关;２例与夜间鼾声有关;但均未见呼吸暂停或呼吸不足表现。结论：癫痫患者可伴随不同程度的睡眠障碍,这可能与睡眠中周期性肢体活动,夜间打鼾,痫样放电或抗痫     

Polysomnographically determined sleep and body mass index in patients with insomnia

We assessed associations between polysomnographically determined sleep, especially the amount of slow-wave sleep (SWS), and body mass index (BMI) in patients with insomnia. One hundred and forty-one insomniacs and 55 healthy volunteers completed overnight polysomnographic recordings, and we measured height and body weight. No significant correlations were obtained between total sleep time and BMI among insomniacs. Compared with normal volunteers, insomnia patients exhibited longer sleep latency and shorter total sleep duration. While the two groups had no significant differences in BMI, insomniacs presented with more N1 but less time spend in SWS and rapid eye movement sleep (REMS). Based on their SWS time, we divided insomnia patients into three groups: short (26.99±13.88), intermediate (59.24±8.12), and long (102.21±26.17) SWS groups. The short-SWS group had significantly greater BMI than the long-SWS group. Further analyses with multiple linear regression showed a significant negative correlation between the amount of SWS and BMI scores in insomniacs, whereas no such correlation was found in healthy volunteers after controlling for potential confounds (e.g., age, sex and AHI). Our study suggests that low amounts of SWS may be associated with higher BMI in patients with insomnia.     

早期帕金森病患者多巴胺能药物与夜间睡眠的相关性探讨

目的探索帕金森病（PD）患者多巴胺能药物与夜间主观和客观睡眠之间的关系。方法收集本院2010年10月至2013年6月门诊诊疗的帕金森病患者的人口学特征和疾病信息,所有患者行整夜视频多导睡眠图、完成PD睡眠量表（SCOPA-SLEEP）,采集用药信息,包括服药与就寝时间,转化为左旋多巴当量。结果共有41例男性、20例女性患者纳入研究,中位年龄63．6岁,中位病程5年。经过年龄、性别、疾病严重程度和病程校正,更高的左旋多巴等效剂量（LED4H）与更高的SCOPA-NS（P〈0．05）及入睡后觉醒时间（P〈0．05）相关。更高剂量就寝前多巴胺能药物摄人与快速动眼（REM）睡眠时间百分比减少相关（P〈0．05）。结论就寝前服用更高剂量多巴胺能药物与更少的REM睡眠及更差的睡眠质量相关。尽管PD患者睡眠质量不佳由多种因素引起,但仍建议将睡前服药剂量和时间纳入帕金森病患者管理当中。     

阻塞性睡眠呼吸暂停低通气综合征患者凌晨血压和血液流变学的变化

目的探讨不同程度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者凌晨血压、血液流变学的变化。方法依据呼吸暂停低通气指数将2006年4月至2007年7月在我科确诊为OSAHS的118例患者分为轻（31例）、中（40例）、重度（47例）3组,同时选择25例健康人作为对照组,记录血氧饱和度〈90％的累积时间占总监测时间的百分比（TS90％）,测定血液流变学及凌晨血压升高值。结果OSAHS重度组出现凌晨血压增高的21例（43％）,中度组的8例（20％）,轻度组1例（3％）;血液流变学各指标值、TS90％值OSAHS组均高于正常对照组（P〈0．05）,中度和重度组高于轻度组（P〈0．05）,重度组显著高于中度组（P〈0．05）;凌晨血压增高组的血液流变学各指标值均明显高于非凌晨血压增高组（P〈0．05）。结论OSAHS患者血液黏稠度、凌晨血压增高比例、TS90％值随阻塞程度增加而升高,血液流变学的变化与凌晨血压增高相关。     

空姐式服务模式对提高SAS治疗依从性的疗效评估

目的 探讨引用空姐式服务模式提高睡眠呼吸暂停综合症（SAS）患者治疗的依从性。方法 对通过多导睡眠图监测确诊为SAS的重度患者86例进行分组护理干预。治疗组为在护理干预中引入空姐式服务模式,对照组为常规护理干预,对照分析。结果 治疗前后第1周,2组治疗的依从性、Epworth得分无差异统计学意义;治疗第2周起,2组均为差异有统计学意义,P〈0．01。结论 空姐式服务模式对提高SAS治疗依从性是积极有效的。     

Referral for a Bariatric Surgical Consultation: It is Time to Set a Standard of Care

Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician’s responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.     

Treatment of obstructive sleep apnea with continuous nasal airflow

Although nasal continuous positive airway pressure (CPAP) is effective therapy for obstructive sleep apnea (OSA), it requires a customfitted nasal appliance and large cumbersome tubing. We therefore designed and tested a new device (NFLOW) to deliver airflow to the nose of patients with OSA. We studied 13 patients the first night without treatment and the following night with NFLOW. The degree of sleep apnea was assessed by the number of desaturations per hour of sleep and the average maximum desaturation per episode. Treatment with NFLOW significantly decreased all parameters (P<0.01) in 9 patients (69%) who tolerated treatment flow rates above 30 LPM. REM sleep time significantly increased with NFLOW use, however, other sleep stage times were not significantly altered. Obstructive apneas ceased in all but 2 of these patients with treatment. Four patients did not tolerate flow rates above 35 LPM and did not improve. We conclude that NFLOW treatment significantly decreases the number of oxyhemoglobin desaturations and improves oxyhemoglobin saturation in patients with OSA who tolerate the procedure.     

高原COPD患者夜间睡眠及SaO2变化特点及意义

探讨COPD夜间睡眠结构及血氧饱和度变化 ,以期为临床提供诊疗依据。方法 :应用多导睡眠记录仪进行睡眠监测 ,测定项目包括脑电图、眼动图、心电图、颏肌肌电图、口鼻气流、胸腹呼吸运动、血氧饱和度共 7个参数 ;结果 :与健康人组比较 ,COPD组Ⅰ期、Ⅱ期睡眠时间无显著性差异 (P >0 .0 5 ) ,但Ⅲ期、Ⅳ期时间、人睡后醒觉次数大于 5分钟 ,浅睡眠的比率、深睡眠的缺乏率及REM缺乏率均有显著性差异 (P <0 .0 1～ 0 .0 0 1 )。COPD组氧饱和度降低≥ 4% ,氧减饱和度 85 %～ 5 0 %频率分布 ,夜间最高、最低和平均氧饱和度、SIT85 %、△SaO2 均与健康人有显著性差异 (P <0 .0 0 1 )。结论 :COPD患者组存在有严重的睡眠呼吸紊乱和睡眠的破碎 ,同时存在有严重的夜间低氧血症和呼吸暂停 ,因此 ,加强对COPD患者夜间睡眠和SaO2 监测 ,对于提高患者的生命质量具有十分重要的意义。