持续气道正压通气治疗缺血性脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的疗效评估

摘要

目的 分析自动压力模式持续气道正压通气(Auto-CPAP)对于急性缺血性脑卒中合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)的疗效.方法 选择脑卒中患者122例,将合并OSAHS的78例患者随机分为阴性对照组34例和治疗组44例.治疗组在常规治疗基础上,加用Auto-CPAP治疗.将未合并OSAHS的44例脑梗死患者为空白对照组,只接受常规治疗.入院时及治疗后7、14、28 d进行美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数评分以评估疗效.结果 与空白对照组比较,阴性对照组和治疗组呼吸暂停低通气指数明显升高(P＜0.05)；与阴性对照组比较,入院第7、14、28天,治疗组和空白对照组NIHSS评分明显降低,Barthel指数评分明显升高(P＜0.05).入院时与入院第7、14、28天NIHSS评分和Barthel指数评分分别做差值,结果显示,Auto-CPAP治疗可使合并OSAHS的脑梗死患者明显获益(P＜0.05),而不同程度OSAHS患者的差值结果显示,Auto-CPAP治疗使中重度OSAHS获益更多.结论 急性缺血性脑卒中合并OSAHS早期应用Auto-CPAP治疗,能有效改善患者神经功能缺损,中重度OSAHS患者获益更多.%Objective To analyze the curative effect of continuous positive airway pressure(CPAP) therapy on acute ischemic stroke accompanying obstructive sleep apnea hypopnea syndrome (OSAHS). Methods One hundred and twenty-two acute ischemic stroke patients were enrolled in this study. Of these patients, 78 with OSAHS were randomly divided into negative control group(n = 34) and treatment group(n = 44) ,the other 44 without OSAHS served as a blank con trol group. Patients in treatment group received routine treatment + CPAP therapy and those in blank control group received routine therapy. Curative effect of CPAP therapy on acute ischemic stroke in treatment group and blank control group was assessed according to the NIHSS and Bar thel index at admission and on days 7,14 and 28 after treatment. Results The apnea hypopnea in dex was significantly higher in negative control group and treatment group than in blank control group(P<0. 01). The NIHSS scores were significantly lower whereas the Barthel index was sig nificantly higher in treatment group and blank control group than in negative control group on days 7,14 and 28 after treatment(P<0. 05). The D-value for NIHSS scores and Barthel index at admission and on days 7,14 and 28 after treatment showed that CPAP therapy could significantly improve acute ischemic stroke accompanying OSAHS while the D-value for OSAHS could signifi cantly improve severe OSAHS(P<0. 05). Conclusion Early CPAP therapy can effectively im prove the nerve injury in acute ischemic stroke patients,especially in those with moderate or se vere OSAHS.