应用经颅多普勒超声评价OSAHS患者脑血流储备的变化及其与突发性脑血管事件的关系  

Changes of cerebrovascular reserve of obstructive sleep apnea hypopnea syndrome patients evaluated by transcranial cerebral Doppler and its relationship with stroke

作　　者：宋学萍[1,2] 于士龙[3] 杨惠娟[1] 郭阳[4] 谢惠芳[4] 祝淑贞[4] 潘速跃[1] 

机构地区：[1]南方医科大学南方医院神经内科,广州510515 [2]广州市白云区人民医院神经内科,510500 [3]吉林省肿瘤医院介入科,长春130000 [4]南方医科大学珠江医院神经内科,广州510280

出　　处：《中华神经医学杂志》2015年第5期493-496,共4页Chinese Journal of Neuromedicine

基　　金：广州市白云区科技计划项目（2012-KZ-13）

摘　　要：目的 应用经颅多普勒超声（TCD）评价阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者脑血流储备（CVR）的变化及其与脑血管突发事件的关系.方法 选择自2012年6月至2013年1月在南方医科大学南方医院、广州医学院第一附属医院、广州市白云区人民医院神经内科和睡眠呼吸中心就诊并确诊为OSAHS的患者126例,根据多导睡眠图（PSG）检测结果将OSAHS患者分为轻度OSAHS组（49例）、中度OSAHS组（44例）、重度OSAHS组（33例）;选择同期广州市白云区人民医院的健康体检人员40例做为对照组.应用TCD检测双侧大脑中动脉的CVR,比较4组受试者大脑中动脉的收缩储备、扩张储备、整体储备及2年随访时间内突发性脑血管事件的发生情况.结果 与对照组和轻度OSAHS组比较,中度、重度OSAHS组患者收缩储备、扩张储备、整体储备均下降,差异有统计学意义（P＜0.05）.与中度OSAHS组比较,重度OSAHS组患者收缩储备、扩张储备、整体储备均下降,差异有统计学意义（P＜0.05）.在2年的随访时间内,重度OSAHS组患者突发性脑血管事件的发生率（12.12％）高于对照组（0％）及轻度（0％）、中度OSAHS组（4.55％）,差异有统计学意义（P＜0.05）.结论 OSAHS患者的病情越重,CVR越低.重度OSAHS患者的脑血管突发事件发生率明显较高.Objective To evaluate the changes ofcerebrovascular reserve （CVR） of patients with obstructive sleep apnea hypopnea syndrome （OSAHS） by transcranial cerebral doppler （TCD） and to study its relation with stroke.Methods One hundred and twenty-six patients with OSAHS,admitted to our hospitals from July 2012 to January 2013 and diagnosed as having OSAHS,were chosen in our study;they were divided into mild OSAHS group （n=49）,moderate OSAHS group （n=44） and severe OSAHS group （n=33） according to test results of polysomnography （PSG）.Another 40 healthy controls were collected.The CVR of all subjects were evaluated by TCD merging with CO2 experiment and compared among different groups.All the subjects were accepted continued two-year follow-up and recorded the accidents of stroke.The morbidities of stroke were compared between different groups.Results As compared with those in the control group and mild OSAHS group,all of the contractile reserve,dilatation reserve and overall reserve descended in moderate OSAHS group and severe OSAHS group with statistically significant differences （P〈0.05）.As compared with those in the moderate OSAHS group,all of the contractile reserve,dilatation reserve and overall reserve descended in severe OSAHS group,and the differences were statistically significant （P〈0.05）.In the two years of follow-up,the incidence of stroke in the severe OSAHS group （12.12%） was significantly higher than that in the control group （0%）,mild OSAHS group （0%） and moderate OSAHS group （4.55%,P〈0.05）.Conclusion The heavier the condition of OSAHS,the more obviously descended the CVR;the stroke morbidity of severe OSAHS patients is increased significantly.

关 键 词：经颅多普勒超声 脑血流储备 阻塞性睡眠呼吸暂停低通气综合征 突发性脑血管事件 

分 类 号：R766.4[医药卫生—耳鼻咽喉科]