无创呼吸机对急性缺血性脑卒中伴阻塞性睡眠呼吸暂停低通气综合征患者血清炎症因子及认知功能的影响  

Effect of non-invasive ventilator in the treatment of acute ischemic stroke complicated with obstructive sleep apnea hypopnea syndrome and its influence on serum inflammatory factors and cognitive function

作　　者：徐玲 季晓宇[1] 常焕显[1] 刘丽艳[1] 赵平 洪波 孔令胜[1] 韩学聃 张晓 梁婷婷 刘美玲 Xu Ling;Ji Xiaoyu;Chang Huanxian(Department of Neurology,Lianyungang East Hospital,Lianyungang 222042)

机构地区：[1]连云港市东方医院神经内科,江苏连云港222042

出　　处：《中国现代医药杂志》2023年第11期28-34,共7页Modern Medicine Journal of China

基　　金：连云港市卫生科技项目(编号:202229)。

摘　　要：目的探讨无创呼吸机治疗对急性缺血性脑卒中(AIS)伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清炎症因子、认知功能及预后的影响。方法采用随机数字表法将108例AIS并OSAHS患者分为对照组(52例)和观察组(入组56例,完成治疗52例)。对照组给予常规治疗及康复训练,观察组在对照组基础上采用无创呼吸机双水平气道正压通气(BIPAP)治疗。两组患者均治疗12周。治疗前后分别检测两组患者睡眠结构指标[非快速眼球运动的快波浅睡眠(N1-N2)期占比、非快速眼球运动的慢波深睡眠(N3-N4)期占比、快速眼球运动(REM)期占比及微觉醒指数(MAI)],睡眠质量指标[呼吸暂停低通气指数(AHI)、最长呼吸暂停时间(LAT)、最低血氧饱和度(LSaO2)及Epworth嗜睡量表(ESS)评分],血清炎症因子指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],血管内皮功能指标[一氧化氮(NO)和内皮素-1(ET-1)],认知功能指标[蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)],神经功能指标[美国国立卫生研究院卒中量表(NIHSS)、Barthel指数]。随访治疗后12个月内两组患者不良心脑血管事件再发情况。结果观察组患者睡眠结构、睡眠质量、血清炎症因子、血管内皮功能、认知功能及神经功能指标的改善优于对照组(均P<0.05);治疗后12个月内,观察组患者不良心脑血管事件的再发率低于对照组(χ2=10.400,P=0.001);治疗12周后患者的睡眠质量、炎症因子、血管内皮功能指标与认知功能及神经功能评分之间呈现高度相关或极高度相关(均|r|>0.70)。结论无创呼吸机治疗AIS并OSAHS患者,可改善患者睡眠质量,降低炎症因子水平,改善血管内皮功能,提高认知功能,减轻神经功能缺损程度,降低不良心脑血管事件的再发率。Objective To investigate the effect of non-invasive ventilator therapy on serum inflammatory factors,cognitive function and the prognosis in patients with acute ischemic stroke(AIS)complicated with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods 108 patients with AIS complicated with OSAHS were randomly divided into the control group(52 cases)and the observation group(56 cases,52 cases being completed treatment)by digital table method.The control group received routine treatment and rehabilitation training,the observation group was treated with non-invasive double-level positive airway pressure on the basis of the control group.Both groups were treated for 12 weeks.Sleep structure indexes[proportion of fast wave sleep(N1-N2)phase,proportion of slow wave sleep(N3-N4)phase,proportion of rapid eye movement(REM)phase and micro-awakening index(MAI)],sleep quality indexes[apnea hypopnea index(AHI),longest apnea duration(LAT),minimum blood oxygen saturation(LSaO2)and Epworth sleepiness scale(ESS)score],serum inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],vascular endothelial function[nitric oxide(NO)and endothelin-1(ET-1)],cognitive function[Montreal Cognitive Assessment Scale(MoCA),mini-mental status examination(MMSE)]and neurological function indicators[National Institutes of Health Stroke Scale(NIHSS),Barthel Index]were detected before and after treatment.The recurrent cardiac and cerebrovascular events in both groups were followed up within 12 months after treatment.Results The improvement of sleep structure,sleep quality,serum inflammatory factors,vascular endothelial function,cognitive function and neural function indexes in the observation group were better than those in the control group(all P<0.05).Within 12 months after treatment,the incidence of recurrent cardiac and cerebrovascular events in the observation group were lower than that in the control group(χ2=10.400,P=0.001).After 12 weeks of treatment,the correlation analysis of sleep quality,inflammatory factors,vascular

关 键 词：无创呼吸机 缺血性脑卒中 阻塞性睡眠呼吸暂停低通气综合征 睡眠质量 炎症反应 认知功能 

分 类 号：R766[医药卫生—耳鼻咽喉科] R743.3[医药卫生—临床医学]