椎基底动脉供血不足支架植入对改善睡眠呼吸暂停低通气综合征的初步观察  

The effect of percutaneous transluminal stenting for vertebrobasilar ischemia on sleep apnea hypopnea syndrome

作　　者：胡洁[1] 张杰[1] 黄倩[1] 陈启东[2] 金民[3] 董可辉[2] 

机构地区：[1]首都医科大学附属北京天坛医院呼吸科,100050 [2]首都医科大学附属北京天坛医院神经内科,100050 [3]首都医科大学附属北京天坛医院神经介入科,100050

出　　处：《中华结核和呼吸杂志》2007年第12期904-907,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的观察椎基底动脉缺血发作与睡眠呼吸暂停低通气综合征(SAHS)之间的关系,以及椎动脉内支架植入治疗对 SAHS 的作用。方法对20例椎动脉血管内支架成形术患者在治疗前后进行多导睡眠图监测,同时记录患者的一般资料和临床表现,填写 Epworth 嗜睡程度量表。按照成人 SAHS 的诊断标准进行诊断、分型,判断其严重程度及缺氧变化。治疗前后的比较采用配对 t 检验和秩和检验,偏态分布的计量资料以中位数和四分位间距表示。结果 20例椎基底动脉缺血性狭窄患者合并 SAHS 者17例,其中轻度10例、中度3例、重度4例,临床类型符合阻塞性睡眠呼吸暂停低通气综合征(OSAHS)。治疗后患者的呼吸暂停低通气指数[5.0(1.6～12.7)次/h]、最长呼吸暂停时间[(19.5±12.4)s]、呼吸暂停低通气时间占总睡眠时间百分比[2.3(0.6～9.8)%]、每小时动脉血氧饱和度下降4%的次数[5.8(2.7～17.0)次/h]明显低于治疗前[11.3(6.3～23.6)次/h、(31.5±18.6)s、6.9(2.6～14.3)%、10.1(5.3～29.0)次/h],治疗后患者的夜间最低动脉血氧饱和度[(86.1±3.3)%]明显高于治疗前[(83.6±7.1)%]。结论椎基底动脉缺血患者的睡眠结构紊乱,睡眠效率降低。患者具有较高的 SAHS 患病率,主要造成阻塞性睡眠呼吸暂停。椎动脉血管内支架成形术治疗可改善缺血性脑血管病患者的睡眠呼吸紊乱及缺氧状况。Objective To evaluate the relationship between vertebrobasilar ischemia （VBI） and sleep apnea hypopnea syndrome （SAHS） and the effect of percutaneous transluminal stenting for VBI on the clinical parameters of SAHS. Methods Twenty patients with VBI were included for clinical history, physical examination with sleep quentionnaires and scored by the Epworth Sleepiness Scale （ESS）. Polysomnographic （PSG） studies were performed before and after vascular stenting for VBI. The relationship among clinical factors, the incidence and characteristics of SAHS were analyzed. The changes of apnea hypopnea index （AHI）, longest apnea duration （LAD）, the total time of apnea and hypopnea （AH%）, the lowest arterial saturation （ LSaO2 ） and oxygen desaturation index （ ODI4 ） before and after vascular stenting were compared. Results PSG studies were performed in 20 cases of VBI. SAHS was confirmed in 17 of the 20 patients, including mild （ 10/20 ）, moderate （3/20） and severe （4/20）, all were of obstructive. Before stenting therapy, AHI was 11.3 /h（6. 3 - 23. 6）/h, but was 5.0/h（ 1.6 - 12. 7）/h after therapy. LADwas （31.5±18.6） s vs （19.5±12.4） s, LSaO2 was （83.6±7. 1）% vs （86.1±3.3）%, the AH% was [2.3（0.6% -9.8）%] vs [6.9% （2.6 - 14.3）%],ODI4 was 10. 1/h（5.3 - 29.0）/h vs 5.8 /h（2.7 -17.0）/h, respectively before and after stenting. AHI, LAD and ODI4 were significantly decreased and LSaO2 was increased after stenting for VBI. Conclusion This series of patients with cerebravascular ischemia caused by vertebrobasilar artery stenosis had a high prevalence of obstructive sleep apnea. Vertebrobasilar vascular stenting was shown to be a reliable method of decreasing the degree of sleep-disordered breathing and hypoxia for SAHS patients with vertebrobrobasilar arterv stenosis.

关 键 词：椎基底动脉供血不足 支架 睡眠呼吸暂停综合征 

分 类 号：R743[医药卫生—神经病学与精神病学] R56[医药卫生—临床医学]