无创呼吸机治疗脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的短期预后和卒中复发的影响因素分析  

Short-term Effect And Risk Factor For Continuous Positive Airway Pres-sure Therapy on Patients With Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：袁烨[1] 赵秉清[1] 

机构地区：[1]北京市石景山医院神经内科二病区,北京100043

出　　处：《中外医疗》2016年第16期5-8,26,共5页China & Foreign Medical Treatment

摘　　要：目的探讨持续正压通气（CPAP）治疗脑卒中合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的1年预后,并分析影响卒中复发的危险因素。方法整群选择该院自2014年1月—2015年12月脑卒中合并OSAHS的患者107例,按照随机数字表将其分为CPAP组和对照组。随访1年,比较两组的卒中复发率,并应用受试者工作特征性（ROC）曲线分析预测脑卒中复发的危险因素。结果入选的107例患者中,CPAP组有51例患者,对照组有56例。两组间的一般情况、基础疾病、睡眠呼吸暂停指数（AHI）、Epworth嗜睡量表（ESS）评分、NIHSS评分和Barthel指数评分等差异无统计学意义（P〉0.05）。随访发现,住院期间两组的AHI、NIHSS、ESS、Barthel指数均有统计学意义（P〈0.05）。随访1年时,两组间的脑卒中再发率差异有统计学意义（P〈0.05）。ROC曲线显示年龄（AUC 0.71,95%CI=0.63-0.78,P=0.003）、AHI（AUC 0.74,95%CI=0.61-0.83,P=0.001）和高血压（AUC 0.79,95%CI=0.64-0.87,P=0.01）为预测脑卒中复发的危险因素。结论 CPAP能有效改善脑卒中合并OSAHS患者的睡眠呼吸障碍、日间嗜睡和神经功能缺损,长期应用能降低恢复期脑卒中复发率。高龄、高血压和睡眠呼吸暂停指数为脑卒中复发的危险因素。Objective To evaluate 1-year effect of continuous positive airway pressure（CPAP） therapy for patients with obstructive sleep apnea hypopnea syndrome（OSAHS） and the risk factor for stroke recurrence. Methods 107 patients with stroke in Beijing Shijingshan Hospital from January 2014 to January 2015 were randomly separated into CPAP group and control group. We compared the risk of stroke recurrence. Furthermore, we evaluated the risk factor for stroke recurrence using receptor-operating characteristic（ROC） curves. Results 107 stroke patients were enrolled. There were 51 patients in CPAP group and 56 patients in the control group. Basic characteristics were comparable between the two groups（P〉0.05）.There was significant difference in AHI, NIHSS, ESS and Barthel index between groups（P〉0.05）. Additionally, rate of stroke recurrence was also markedly different between groups（P〈0.05）. ROC curve showed that age（AUC 0.71, 95% CI=0.63-0.78,P=0.003）, AHI（AUC 0.74, 95% CI=0.61-0.83,P=0.001） and hypertension（AUC 0.79, 95% CI=0.64-0.87,P=0.01） are the risk factors for stroke recurrence.Conclusion CPAP could significantly improve sleeping dysfunction, day sleepiness and neurologic injury. Long-term CPAP treatment might decrease stroke recurrence. Age, AHI and hypertension were independent risk factors for stroke recurrence.

关 键 词：卒中 阻塞性睡眠呼吸暂停低通气综合征 持续气道正压通气 危险因素 

分 类 号：R4[医药卫生—临床医学]