CAJ | 학술논문

目的分析双水平气道正压无创通气(BiPAP)对急性脑梗死合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者进行辅助呼吸治疗的临床疗效. 方法前瞻性收集广州市白云区人民医院神经内科自2010年12月至2013年1月间收治的急性脑梗死合并OSAHS患者127例,按随机数字表法将患者分为BiPAP组(62例)和对照组(65例),所有患者接受缺血性脑卒中的常规治疗,BiPAP组除常规治疗外接受BiPAP治疗.每组患者再分为4个亚组:完全前循环梗死(TACI)组、部分前循环梗死(PACI)组、后循环梗死(POCI)组,腔隙性梗死(LACI)组.对患者在治疗前、治疗后1、2、4、8、12、24周进行美国国立卫生研究院卒中量表(NIHSS)评分,并记录患者入组后24周内出现的临床事件. 结果与对照组中相同亚组相同时间点比较,BiPAP组中POCI亚组治疗后1、2、4、8、12、24周NIHSS评分降低,TACI亚组治疗后2、4、8、12、24周NIHSS评分降低,PACI亚组治疗后4、8、12周NIHSS评分降低,差异均有统计学意义(P＜0.05)；LACI亚组治疗后各时间点NIHSS评分无明显变化,差异无统计学意义(P＞0.05)；与对照组比较,BIPAP组死亡、再发脑卒中、短暂性脑缺血发作、心肌梗死、肺炎和卒中后抑郁发生率的差异均无统计学意义(P＜0.05). 结论 BiPAP辅助呼吸可以改善TACI、PACI、POCI合并OSAHS患者的预后并减低致残级别,但不能减少临床事件的发生.
목적 분석쌍수평기도정압무창통기(BiPAP)대급성뇌경사합병조새성수면호흡잠정저통기종합정(OSAHS)환자진행보조호흡치료적림상료효. 방법 전첨성수집엄주시백운구인민의원신경내과자2010년12월지2013년1월간수치적급성뇌경사합병OSAHS환자127례,안수궤수자표법장환자분위BiPAP조(62례)화대조조(65례),소유환자접수결혈성뇌졸중적상규치료,BiPAP조제상규치료외접수BiPAP치료.매조환자재분위4개아조:완전전순배경사(TACI)조、부분전순배경사(PACI)조、후순배경사(POCI)조,강극성경사(LACI)조.대환자재치료전、치료후1、2、4、8、12、24주진행미국국립위생연구원졸중량표(NIHSS)평분,병기록환자입조후24주내출현적림상사건. 결과 여대조조중상동아조상동시간점비교,BiPAP조중POCI아조치료후1、2、4、8、12、24주NIHSS평분강저,TACI아조치료후2、4、8、12、24주NIHSS평분강저,PACI아조치료후4、8、12주NIHSS평분강저,차이균유통계학의의(P＜0.05)；LACI아조치료후각시간점NIHSS평분무명현변화,차이무통계학의의(P＞0.05)；여대조조비교,BIPAP조사망、재발뇌졸중、단잠성뇌결혈발작、심기경사、폐염화졸중후억욱발생솔적차이균무통계학의의(P＜0.05). 결론 BiPAP보조호흡가이개선TACI、PACI、POCI합병OSAHS환자적예후병감저치잔급별,단불능감소림상사건적발생.
Objective To explore the curative effect of noninvasive ventilation with bi-level positive airway pressure (BiPAP) on acute cerebral infarction patients with obstructive sleep apnea and hypoventilation syndrome (OSAHS).Methods One hundred and twenty-seven acute cerebral infarction patients with OSAHS,admitted to our hospital from December 2010 to January 2013,were prospectively collected; they were randomly divided into BiPAP treatment group (n=93) and control group (n=93),and all the patients received conventional treatment of ischemic stroke,and patients in the BiPAP treatment group also accepted BiPAP treatment; patients in these two groups were divided into four subgroups:total anterior circulation infarct (TACI) group,partial anterior circulation infarct (PACI) group,posterior circulation infarct (POCI) group and lacunar circulation infarct (LACI) group.NIHSS was employed on the patients before treatment,and 1,2,4,8,12 and 24 weeks after treatment.All the clinical events of the patients within 24 weeks of treatment were recorded.Results The NIHSS scores in BiPAP treatment patients of POCI subgroup 1,2,4,8,12 and 24 weeks after treatment were significantly increased as compared with those in the control patients of POCI subgroup at the same time points (P＜0.05); the NIHSS scores in BiPAP treatment patients of TACI subgroup 2,4,8,12 and 24 weeks after treatment were significantly increased as compared with those in the control patients of TACI subgroup at the same time points (P＜0.05); the NIHSS scores in BiPAP treatment patients of PACI subgroup 4,8 and 12 weeks after treatment were significantly increased as compared with those in the control patients of PACI subgroup at the same time points (P＜0.05); however,no significant difference was noted in LACI subgroup at each time points (P＞0.05).No statistical differences on incidences of death,recurrent stroke,transient cerebral hemorrhage attack,myocardial infarction,pneumonia and stroke depression were noted between the two groups (P＞0.05).Conclusion Noninvasive ventilation with BiPAP can improve the prognosis and decrease the disability grade of OSAHS patients combined with TACI,PACI or POCI,but can not reduce the rate of clinical events.