口肌生物反馈系统训练对缺血性脑卒中后阻塞性睡眠呼吸暂停患者认知功能障碍康复的影响  

Effects of oral-muscle biofeedback system training on rehabilitation of cognitive impairment in patients with obstructive sleep apnea after ischemic stroke

作　　者：何俊[1] 卢同波 朱金妹[1] 钱雪 焦素芹[1] 言丽香[1] 丁渝权 张丽霞[2] 王彤[2] He Jun;Lu Tongbo;Zhu Jinmei;Qian Xue;Jiao Suqin;Yan Lixiang;Ding Yuquan;Zhang Lixia;Wang Tong(Rehabilitation Center of Changzhou Dean Hospital,Changzhou 213003,China;Rehabilitation Center of Jiangsu Provincial People's Hospital,Nanjing 210000, China)

机构地区：[1]常州市德安医院康复中心,常州213003 [2]江苏省人民医院康复医学中心,南京210000

出　　处：《中华行为医学与脑科学杂志》2018年第12期1100-1104,共5页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：江苏省科技发展计划项目(BE2017752);常州市科技支撑计划项目(CE20175033).

摘　　要：目的探讨口肌生物反馈系统训练对缺血性脑卒中后阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者认知功能障碍康复的影响。方法选择常州市德安医院康复中心于2017年6月至2018年3月期间收治的脑卒中后OSA伴认知功能障碍患者60例,按照数字表法随机分为观察组与对照组,每组各30例。在常规康复治疗基础上,对照组给予正压通气治疗,观察组给予口肌生物反馈系统训练。比较两组治疗前与治疗8周后多导睡眠(Polysomnography,PSG)参数、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分以及血清基质金属蛋白酶-9(matrix metalloproteinase,MMP-9)、血浆同型半胱氨酸(homcysteinemia,Hcy)表达水平变化情况。结果两组患者治疗后呼吸暂停低通气指数(apnea hypopnea index,AHI)、最长呼吸暂停时间较治疗前均明显降低,最低动脉血氧饱和度(SpO2)、平均SpO2较治疗前均明显升高,均差异有统计学意义(P<0.05);治疗后观察组患者MoCA量表各维度评分以及总分明显高于同期对照组,均差异有统计学意义(P<0.05);治疗后观察组患者Hcy水平[(12.38±4.54)μmol/L]、MMP-9表达水平[(124.52±12.94)μg/L]均明显低于同期对照组[Hcy(17.52±6.27)μmol/L,MMP-9(268.25±20.57)μg/L],均差异有统计学意义(Hcy:t=3.637,P<0.05;MMP-9:t=32.395,P<0.05)。结论正压通气与口肌生物反馈系统训练治疗脑卒中后OSA的疗效相当,但口肌生物反馈系统训练更能有效改善患者的认知功能,促进认知障碍康复。Objective To explore the effect of oral-muscle biofeedback system training on the rehabilitation of cognitive dysfunction in patients with obstructive sleep apnea(OSA)after ischemic stroke.Methods A total of 60 cases of poststroke OSA patients with cognitive dysfunction admitted to the rehabilitation center of deAn hospital in changzhou city from June 2017 to March 2018 were selected.On the basis of routine rehabilitation treatment,the control group was given positive pressure ventilation treatment,and the observation group was given oral muscle biofeedback system training.The changes of polysomnography(PSG)parameters,Montreal cognitive assessment(MoCA)score,serum matrix metalloproteinase-9(MMP-9)and plasma homcysteinemia(Hcy)expression levels in the two groups before and after treatment were compared.Results Apnea hypopnea index and maximum apnea time of the two groups were significantly decreased after treatment compared with those before treatment,and the lowest SpO2 and average SpO2 were significantly higher than those before treatment(P<0.05).After treatment,MoCA total score and the dimensions score of patients in the observation group were significantly higher than those in the control group at the same time(P<0.05).After treatment,the levels of Hcy((12.38±4.54)μmol/L)and MMP-9((124.52±12.94)μg/L)in the observation group were significantly lower than those in the control group at the same time(Hcy(17.52±6.27)μmol/L,MMP-9(268.25±20.5 7)μg/L),and the difference was statistically significant(Hcy: t=3.637,P<0.05;MMP-9: t=32.395,P<0.05).Conclusions Positive pressure ventilation and oral muscle biofeedback system training have the same effect on OSA after stroke,but oral muscle biofeedback system training can also effectively improve patients' cognitive function.

关 键 词：口肌生物反馈系统训练 脑卒中 阻塞性睡眠呼吸暂停 认知功能障碍 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R766[医药卫生—临床医学]