经颅多普勒超声监测OSAS患者睡眠呼吸暂停期间的脑血流变化  

The monitoring of cerebral blood flow changes during sleep apnea in patients with OSAS by transcranial Doppler ultrasound

作　　者：周京晶[1] 宣正昊[1] 刘颖[1] 易立[1] 张健[1] 

机构地区：[1]首都医科大学附属北京友谊医院医疗保健中心,北京100050

出　　处：《临床和实验医学杂志》2015年第5期408-410,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的采用经颅多普勒超声(TCD)对阻塞性睡眠呼吸暂停综合征(OSAS)患者的睡眠呼吸暂停期间脑血流变化进行监测。方法选取符合OSAS诊断标准的50例患者,并选取同时期就诊的正常人50例作为对照组,对上述研究者采用TCD仪2 MHz脉冲波探头监测大脑中动脉平均血流速度(MFV),观察有无出现狭窄、闭塞、血流频谱的改变。结果 50例患者中,TCD检查共发现39例异常,发生率为78.0%(39/50),其中有29例为血流速度减慢,发生率为58.0%(29/50),9例为血管狭窄,发生率为18.0%(9/50);12例正常,概率为24.0%(12/50)。50例对照组中,共有10例患者出现TCD检查异常,发生率为20.0%(10/50),OSAS患者TCD异常检出率相比于正常对照组显著升高(P<0.01)。中重度OSAS患者的脑血流异常情况发生率显著高于轻度患者。随访1年,OSAS组共出现8例脑血管事件,发生率为16.0%(8/50),对照组仅有1例,发生率为2.0%(1/50),组间比较差异有统计学意义(P<0.05)。OSAS患者屏气前后大脑中动脉血流速度均相对于正常者升高(P<0.01),屏气后的增加率明显低于正常人群(P<0.01),随着OSAS疾病的严重程度上升,其屏气前后大脑中动脉血流速度明显上升(P<0.05)。结论 OSAS患者由于长期的缺氧而使其容易出现动脉硬化改变,引起脑血流下降或是出现脑动脉狭窄。OSAS越严重,则出现脑血流动力学的异常发生率也就越高,越容易发生脑血管事件。Objective Using transcranial Doppler ultrasonography（ TCD）to detect the cerebral blood flow changes during sleep apnea in patients with obstructive sleep apnea syndrome（ OSAS）. Methods Fifty OSAS patients treated between January 2011 -February 2011 in our hospital and 50 healthy subjects were assigned as OSAS group and control group respectively. The average middle cerebral artery blood flow velocity （ MFV）,stenosis,occlusion and the changes of blood flow spectrum were monitored with TCD. Results TCD examination indicated that of 50 OSAS patients 39（78. 0%）were abnormal,including 29（58. 0%）slow blood flow velocity and 9（18. 0%）vascular stenosis. However,in the control group,10 subjects（20. 0%）had abnormal TCD examination,TCD abnormal rate in OSAS patients was significantly higher than control group（ P ﹤0. 01）. Incidence of abnormal cerebral blood flow in moderately severe OSAS patients was significantly higher than that in patients with mild condition. During 1 year follow-up,cerebrovascular events occurred in 8 patients（16. 0%）in OSAS group;it occurred in 1 subject （2. 0%）in control group,the difference between the two groups was statistically significant（ P ﹤0. 05）. MFV in OSAS patients before and after apnea were higher than normal subjects（ P ﹤0. 01）,and the rate of MFV increase after apnea was lower than normal subjects（ P ﹤0. 01）. With the increase in the severity of OSAS,MFV before and after apnea increased obviously（ P ﹤0. 05）. Conclusion Long-term hypoxia may lead arteriosclerosis in OSAS patients and therefore cerebral blood flow decrease and cerebral artery stenosis. The incidences of cerebral hemody-namic abnormalities and cerebrovascular events are increased with the increase in the severity of OSAS.

关 键 词：阻塞性睡眠呼吸暂停综合征 经颅多普勒超声 脑血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学] R766[医药卫生—诊断学]