天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 639-643.doi: 10.11958/20250596

• 临床研究 • 上一篇    下一篇

持续气道正压通气对合并阻塞性睡眠呼吸暂停综合征的脑梗死患者平均气道压及神经功能的影响

贾建波1(), 孙根2, 顾媛媛1   

  1. 1 郑州市第三人民医院神经电生理科（邮编450000）
    2 郑州市第三人民医院神经内科（邮编450000）
  • 收稿日期:2025-03-03 修回日期:2025-04-22 出版日期:2025-06-15 发布日期:2025-06-20
  • 作者简介:贾建波（1982），男，副主任医师，主要从事神经电生理临床医学方面研究。E-mail：jiajianbo1123@163.com
  • 基金资助:
    河南省医学科技攻关计划项目(LHGJ20220824)

The effect of continuous positive airway pressure ventilation on mean airway pressure and neurological function in stroke patients with obstructive sleep apnea syndrome

JIA Jianbo1(), SUN Gen2, GU Yuanyuan1   

  1. 1 Department of Neuroelectrophysiology, the Third People's Hospital of Zhengzhou, Zhengzhou 450000, China
    2 Department of Neurology, the Third People's Hospital of Zhengzhou, Zhengzhou 450000, China
  • Received:2025-03-03 Revised:2025-04-22 Published:2025-06-15 Online:2025-06-20

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摘要：

目的 探讨持续气道正压通气（CPAP）治疗对合并阻塞性睡眠呼吸暂停综合征（OSAS）的脑梗死患者平均气道压及神经功能的影响。方法 采用前瞻性研究的方法收集245例脑梗死合并OSAS患者资料，其中接受常规药物及康复治疗等基础干预措施者152例，在基础干预措施的基础上给予CPAP治疗者93例，按照1∶1倾向性得分匹配法匹配，分成对照组和观察组各48例，2组治疗周期为14 d。比较2组患者治疗前、治疗14 d后氧减饱和指数（ODI）和最低氧饱和度（LSaO2），呼吸力学指标[气道阻力（Raw）、平均气道压（MPaw）、呼气峰值压（PIP）]，神经功能缺损评分[美国国立卫生院卒中量表（NIHSS）评分、3个月后改良Rankina量表（mRS）评分]及日常生活能力（BI）评分，并评价其疗效及不良反应发生情况。结果 治疗14 d后，2组患者ODI，呼吸力学指标Raw、MPaw、PIP及NIHSS评分、mRS评分明显降低，而LSaO2、BI评分明显增加（P<0.05）；且观察组ODI、Raw、MPaw、PIP、NIHSS评分及mRS评分低于对照组，LSaO2、BI评分高于对照组（P<0.05）。观察组总有效率高于对照组（87.5% vs. 68.8%，χ2=4.937，P<0.05）。2组不良反应发生率比较差异无统计学意义（χ2=0.178，P>0.05）。结论 CPAP治疗脑梗死合并OSAS患者有利于降低其MPaw，改善氧饱和度及神经功能，提高总有效率，可在临床推广应用。

关键词: 持续气道正压通气, 睡眠呼吸暂停，阻塞性, 脑梗死, 平均气道压, 神经功能

Abstract:

Objective To investigate the effects of continuous positive airway pressure (CPAP) on mean airway pressure and neurological function in cerebral infarction patients with obstructive sleep apnea-hypopnea syndrome (OSAS). Methods A total of 245 patients with cerebral infarction complicated with OSAS (who received treatment in our hospital from February 2020 to October 2023) were collected and studied by prospective study. Among them, 152 patients received basic intervention measures such as conventional drugs and rehabilitation therapy, and 93 patients received CPAP therapy on the basis of basic intervention measures. Matching according to 1∶1 propensity score matching method, 48 cases were divided into the control group and 48 cases were used as the observation group. The treatment period of the two groups was 14 days. Before treatment and after 14 days of treatment, the oxygen desaturation index (ODI), lowest oxygen saturation (LSaO2), respiratory mechanics indexes [airway resistance (Raw), mean airway pressure (MPaw) and peak inspiratory pressure (PIP)], neurological function scores [National Institutes of Health Stroke Scale (NIHSS) score, modified Rankina scale (mRS) score after 3 months] and Barthel index (BI) score were compared between the two groups, and the efficacy and the occurrence of adverse reactions were evaluated. Results After 14 days of treatment, the ODI, respiratory mechanics indexes Raw, MPaw, PIP, NIHSS score and mRS score were greatly reduced in the two groups, however, LSaO2 and BI score was increased (P<0.05). The ODI, Raw, MPaw, PIP, NIHSS score and mRS score were lower in the observation group than those of the control group, while LSaO2 and BI score were higher in the observation group than those of the control group (P<0.05). The total effective rate of the observation group was higher than that of the control group (87.5% vs. 68.8%, P=0.026). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.673). Conclusion CPAP is beneficial for reducing MPaw, improving oxygen saturation and neurological function, and increasing total effective rate in patients with cerebral infarction combined with OSAS. It can be widely applied in clinical practice.

Key words: continuous positive airway pressure, sleep apnea, obstructive, brain infarction, mean airway pressure, neurological function

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