正压通气联合银杏叶提取物对急性脑梗死合并阻塞性睡眠呼吸暂停综合征患者脑血流动力学及血液流变学的影响

摘要

目的 观察持续气道正压通气(CPAP)联合银杏叶提取物治疗脑梗死合并阻塞性睡眠呼吸暂停综合征(OSAHS)患者疗效及对脑血流动力学与血液流变学的影响.方法将100例脑梗死合并OSAHS患者随机分为观察组与对照组,每组50例.对照组给予常规药物治疗、康复治疗与CPAP,观察组在对照组治疗基础上给予银杏叶提取物静脉滴注,连续治疗14 d.观察2组治疗前与治疗2周、2个月、6个月后脑循环参数[经颅多普勒超声(TCD)检测双侧椎动脉(VA)、大脑中动脉(MCA)、大脑前动脉(ACA)阻力指数(RI)]、血液流变学及神经功能[神经功能缺损评分(NIHSS)、日常生活能力评分(ADL)]变化情况,统计2组总体疗效和治疗期间不良事件发生情况.结果 治疗2周、2个月、6个月后2组双侧VA、MCA、ACA的RI和血液流变学指标、NIHSS评分均低于治疗前(P均<0.05),且观察组均低于同期对照组(P均<0.05);2组ADL评分均高于治疗前(P均<0.05),且观察组均高于同期对照组(P均<0.05).观察组治疗总体有效率高于对照组(P<0.05),病死率明显低于对照组(P<0.05).6个月随访期内,观察组再发脑梗死和心血管事件发生率均明显低于对照组(P均<0.05).结论 CPAP联合银杏叶提取物治疗脑梗死合并OSAHS患者可通过改善大脑动脉血流及血液流变性来促进患者神经系统功能的恢复,减少再发脑梗死及心血管事件的发生率,降低病死率,且方法安全可靠.%O bjective It is to observe the curative effect of continuous positive airway pressure ventilation(CPAP)com-bined with Gingko biloba extract(GBE)on cerebral infarction complicated with obstructive sleep apnea hypopnea syndrome (OSAHS)and on cerebral hemodynamics and blood rheology.Methods 100 patients with cerebral infarction complicated with OSAHS were randomly divided into observation group(n=50)and control group(n=50).The patients in the control group were given conventional drug therapy and rehabilitation and CPAP,and the patients in the observation group were given GBE additionally by intravenous drip,both groups were treated for 14 days.The changes of cerebral hemodynamics[(bilateral re-sistance index(RI)in vertebral artery(VA),arteria cerebri media(MAC),and arteria cerebri anterior(ACA)detected by Transcranial Doppler],blood rheology and neurological function index[National Institutes of Health Stroke Scale(NIHSS) and Activities of daily living(ADL)]were observed before treatment and after treatment for 2 weeks,2 months and 6 months in both groups, the curative effect and occurrence of side effects were evaluated.Results After treatment for 2 weeks, 2 months and 6 months,RI of VA,MCA,ACA in both side, indexes of hemodynamics, NIHSS scores were lower while ADL scores were higher than those before treatment in both groups,and the improvements in the observation group were better(P<0.05).The overall effectiveness and mortality of observation group were both superior to control group(P<0.05).The oc-currence rates of cerebral re-infraction and cardiac events in the observation group were lower than that in the control group during following up for 6 months.Conclusion CPAP combined with GBE can improve the cerebral hemodynamics and blood rheology in patients with cerebral infarction complicated with OSAHS,thus to promote the recovery of nerve function, reduce cerebral re-infraction and cardiac events,this method is safe and effective.