机构地区:[1]郑州大学第一附属医院呼吸睡眠科,郑州450052
出 处:《医药论坛杂志》2020年第9期11-15,共5页Journal of Medical Forum
基 金:国家自然科学基金(U1804195)。
摘 要:目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)合并胃食管反流病(GERD)所致咳嗽性晕厥的治疗及二者与咳嗽、咳嗽性晕厥的关系。方法收集2013年1月—2019年11月经郑州大学第一附属医院确诊的47例OSAS合并GERD所致咳嗽性晕厥患者,依照治疗方案的差异分成药物治疗组(35例,质子泵抑制剂+促胃动力药)、联合治疗组(12例,药物+无创正压通气),比较治疗前、后不同时期各评分的变化,分析两组疗效及OSAS、GERD与咳嗽、咳嗽性晕厥的关系。结果本组患者47例,年龄36~66岁,平均(47.47±7.55)岁,BMI 24.99~31.95 kg/m^2。两组日间咳嗽症状评分、夜间咳嗽症状评分、ESS评分及Gerd Q评分在治疗后1、3个月时比治疗前有所改善,差异有统计学意义P<0.05);联合治疗组治疗后1、3个月的评分指标与药物治疗组相比差异有统计学意义(P<0.05);日间咳嗽症状评分、夜间咳嗽症状评分、咳嗽性晕厥次数与AHI(r=0.37、0.38、0.31,P<0.05)、DeMeester积分(r=0.31、0.45、0.32,P<0.05)呈正相关,与夜间最低血氧饱和度为负相关(r=-0.33、-0.30、-0.38,P<0.05)。夜间咳嗽症状评分与Gerd Q评分呈正相关(r=0.30,P<0.05)。结论抗反流联合无创正压通气治疗OSAS合并GRED致咳嗽性晕厥效果优于单一抗反流治疗;OSAS及GERD严重程度与咳嗽、晕厥事件的发生有相关性。Objective To explore the treatment of patients with cough syncope caused by obstructive sleep apnea syndrome(OSAS)combined with gastroesophageal reflux disease(GERD)and the correlation between OSAS,GERD and cough,cough syncope.Methods Totally 47 patients with cough syncope caused by OSAS and GERD were collected from the First Affiliated Hospital of Zhengzhou University from January 2013 to November 2019.According to the difference of treatment plan,the patients were divided into drug treatment group(35 cases,proton pump inhibitor+gastric motility drugs)and combined treatment group(12 cases,drug+noninvasive positive pressure ventilation).The changes of each score index were compared at before and different stages after treatment.The therapeutic effects of different treatments and the correlation between OSAS,GERD and cough and cough syncope were analyzed.Results Patients with a total of 47 cases,male 38 cases,female 9 cases,age from 36 to 66 y(47.47±7.55),BMI 24.99~31.95 kg/m^2(28.37±1.90).Compared with before treatment,the scores of daytime cough symptom,nighttime cough symptom,ESS and Gerd Q in the drug treatment group and the combined treatment group were improved at 1 and 3 months after treatment,and the differences were statistically significant(P<0.05);Compared with the drug treatment group,these scores of the combined treatment group at 1 and 3 months after treatment were also improved,and the differences were statistically significant(P<0.05).The daytime cough scores,nighttime cough scores,number of cough syncope were positively correlated with AHI(r=0.37,0.38,0.31,P<0.05)and DeMeester scores(r=0.31,0.45,0.32,P<0.05),and negatively correlated with the minimum oxygen saturation during sleep(r=-0.33,-0.30,-0.38,P<0.05).Conclusion(1)The effect of antireflux treatment combined with non-invasive positive pressure ventilation is better than antireflux treatment in treating patients with cough syncope caused by OSAS combined with GERD.(2)The severities of OSAS and GERD were correlated with cough and syncope.
关 键 词:阻塞性睡眠呼吸暂停综合征 胃食管反流病 咳嗽性晕厥 无创正压通气
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