经鼻持续气道正压通气与高压氧治疗对脑梗死合并阻塞性睡眠呼吸暂停低通气综合征的疗效比较

目的 :比较脑梗死合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者应用经鼻持续气道正压通气(nCPAP)治疗与高压氧治疗后对睡眠、神经功能障碍、认知、心理和日常生活能力的疗效。方法:共129例脑梗死合并OSAHS患者入选本研究,随机分为3组。nCPAP组43例(完成21例),高压氧治疗组44例(完成33例),另42例患者为对照组。3组患者在治疗前、后均进行多导睡眠图(PSG)检测及认知、心理、神经功能、日常生活能力评分,并对相关结果进行对比分析。结果:经nCPAP治疗12周后,nCPAP治疗组呼吸暂停低通气指数(AHI)、最低氧饱和度、氧饱和度低于90%的时间百分比等PSG参数较其他2组明显改善(P<0.01);简易精神状态检查(MMSE)量表总评分及记忆、语言项目较其他2组明显改善(P<0.01);复述项目较对照组明显改善(P<0.05)。高压氧治疗组的欧洲脑卒中量表评分较其他2组明显改善(P<0.01),并较对照组在MMSE量表总评分及记忆、语言项目明显改善(P<0.01)。nCPAP治疗组及高压氧治疗组在Barthel指数(BI)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HRSD)评分较对照组明显改善(P<0.01)。结论:脑梗死合并OSAHS患者经nCPAP治疗12周后,其睡眠、认知较其他2组明显改善;高压氧治疗组在神经功能方面较其他2组明显改善;nCPAP治疗组及高压氧治疗组在心理、日常生活能力均明显改善。

Comparison of efficacy of nasal continuous positive airway pressure with hyperbaric oxygenation therapy in patients with cerebral ischemic stroke complicated with obstructive sleep apnea hypopnea syndrome

Objective To compare the efficacy of nasal continuous positive airway pressure（nCPAP） with hyperbaric oxygenation therapy in patients with cerebral ischemic stroke complicated with obstructive sleep apnea hypopnea syndrome （OSAHS）. Methods One hundred and twenty-nine patients with cerebral ischemic stroke complicated with OSAHS were randomly divided into three groups. Twenty-one of the 43 patients in nCPAP group had completed the treatment for 12 weeks, 33 of the 44 patients in hyperbaric oxygenation group had completed the 4 courses of treatment, and 42 patients were of the control group. Polysomnography（PSG）, mini-mental status examination（MMSE）, European stroke scale, Hamilton anxiety scale （HAMA）, Hamilton depression scale （HRSD） and Barthel index （BI） were evaluated and compared. Results After 12-weeks of nCPAP, the PSG parameters including apnea hypopnea index （AHI）, minimum oxygen saturation, time percentage of oxygen saturation less than 90% in nCPAP treatment group were improved significantly （P〈0.01） when compared with the other 2 groups. The total score of MMSE and memory and language items in nCPAP treatment group were improved significantly when compared with the other 2 groups （P〈0.01）, and retell item was improved significantly when compared with the control group （P〈0.05）. The European stroke scale in hyperbaric oxygenation therapy group was improved significantly when compared with the other 2 groups （P〈0.01）, while MMSE total score, memory and language items were improved significantly when compared with the control group （P〈O.O1）. The scores of BI（P〈0.01）, HAMA（P〈 0.01） and HRSD （P〈0.01） of both the two treatment groups were improved significantly when compared with the control group. Conclusions After 12-weeks of nCPAP, sleep and cognition were improved significantly in patients of cerebral ischemic stroke complicated with OSAHS, while 4-courses of hyperbaric oxygenation therapy improved significantly the neurological function in patients of cerebral ischemic stroke combined with OSAHS. Both the psychology and activity of daily living were improved significantly in the two treatment groups.