本文選題：日間過(guò)度嗜睡 + 中樞性睡眠增多��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在明確中樞性睡眠增多患者動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)的變化,并探討其可能作用的病理生理機(jī)制,為指導(dǎo)臨床治療提供更多依據(jù)。方法:本研究選取2016年2月到2017年2月期間就診于吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科門(mén)診的符合日間過(guò)度嗜睡的診斷標(biāo)準(zhǔn)的研究對(duì)象21例及健康對(duì)照組7例,根據(jù)夜間睡眠監(jiān)測(cè)加多次睡眠潛伏期試驗(yàn)檢查結(jié)果將實(shí)驗(yàn)組分為嗜睡組7例、發(fā)作性睡病不伴RBD組7例、發(fā)作性睡病伴RBD組7例。應(yīng)用經(jīng)顱多普勒超聲聯(lián)合連續(xù)指尖血壓檢測(cè)儀,無(wú)創(chuàng)地同步記錄腦血流速度(CBFV)和動(dòng)脈血壓,采用目前公認(rèn)的傳遞函數(shù)分析(TFA)方法計(jì)算導(dǎo)出腦血流自動(dòng)調(diào)節(jié)參數(shù):相位差(PD)、增益、相關(guān)性,評(píng)價(jià)腦血流自動(dòng)調(diào)節(jié)功能。在發(fā)作性睡病患者中,有7例經(jīng)過(guò)至少1個(gè)月規(guī)范治療后再次行腦血流調(diào)節(jié)檢查,并與治療前進(jìn)行比較。結(jié)果:(1)嗜睡組、發(fā)作性睡病不伴RBD組、發(fā)作性睡病伴RBD組ESS(14.6±3.8、16.4±4.0、18.0±2.9)與對(duì)照組數(shù)值(2.1±1.3)比較均明顯升高,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。嗜睡組、發(fā)作性睡病不伴RBD組、發(fā)作性睡病伴RBD組左相位差(33.97±8.71、35.49±11.72、32.00±13.09)與對(duì)照組數(shù)值(53.15±7.91)比較均明顯下降;嗜睡組、發(fā)作性睡病不伴RBD組、發(fā)作性睡病伴RBD組右相位差(33.95±9.21、36.58±13.30、31.85±8.77)與對(duì)照組數(shù)值(53.54±10.87)比較均明顯下降,不同組別研究對(duì)象的左右相位差差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。不同組別研究對(duì)象的左右增益差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。發(fā)作性睡病伴RBD與不伴RBD相應(yīng)半球的相位差、增益相比,差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(2)發(fā)作性睡病治療前后相比,治療后ESS(11.3±2.0)較治療前ESS(15.6±2.7)降低,其差異具有統(tǒng)計(jì)學(xué)意義(p0.05);治療后左側(cè)PD(43.9±12.54°)與治療前左側(cè)PD(24.79±10.13°)相比,PD差異顯著增加,差異具有顯著統(tǒng)計(jì)學(xué)意義(p0.05)。治療后右側(cè)PD(43.05±14.89°),與治療前左側(cè)PD(25.39±5.50°)相比,PD差異顯著增加,具有統(tǒng)計(jì)學(xué)意義(p0.05),而治療前后的左右增益差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:(1)中樞性睡眠增多患者的動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)功能受損。(2)對(duì)于發(fā)作性睡病伴RBD與不伴RBD的患者,動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)功能受損程度無(wú)差異,可能有相同的病理生理機(jī)制有關(guān)。(3)經(jīng)藥物(哌甲酯、氟西汀或文拉法辛)治療后發(fā)作性睡病患者的動(dòng)態(tài)腦血流自動(dòng)調(diào)節(jié)功能有所改善。
[Abstract]:Objective: to investigate the changes of dynamic cerebral blood flow automatic regulation in patients with central sleepiness and to explore the pathophysiological mechanism of its possible role in order to provide more evidences for clinical treatment. Methods: from February 2016 to February 2017, 21 subjects who met the diagnostic criteria of daytime excessive somnolence in the Department of Neurology, first Hospital of Jilin University, and 7 healthy controls were selected. According to the results of nocturnal sleep monitoring and multiple sleep latency test, the experimental group was divided into narcolepsy group (n = 7), narcolepsy without RBD group (n = 7) and narcolepsy with RBD group (n = 7). The cerebral blood flow velocity (CBFV) and arterial blood pressure were recorded noninvasively by transcranial Doppler ultrasound combined with continuous fingertip blood pressure detector. The parameters of automatic cerebral blood flow regulation were calculated and derived by using the currently accepted transfer function analysis (TFAA) method: phase difference PDV, gain, and so on. To evaluate the function of cerebral blood flow automatic regulation. Among the patients with paroxysmal narcolepsy, 7 patients underwent cerebral blood flow regulation after at least one month of standardized treatment, and were compared with those before treatment. Results compared with the control group, the contents of ESS(14.6 鹵3.8N 16.4 鹵4.0 鹵18.0 鹵2.9 in narcolepsy group, paroxysmal sleepiness group without RBD and paroxysmal sleep disease with RBD group were significantly higher than those in control group (2.1 鹵1.3). The difference was statistically significant (P 0.05). In narcolepsy group, the left phase difference of narcolepsy without RBD and paroxysmal sleep with RBD was 33.97 鹵8.71 鹵35.49 鹵11.72 鹵32.00 鹵13.09) significantly lower than that of control group (53.15 鹵7.91), while in narcolepsy group, paroxysmal sleepiness was not associated with RBD. The right phase difference (33.95 鹵9.21 鹵36.58 鹵13.30 鹵31.85 鹵8.77) in paroxysmal sleepiness with RBD group was significantly lower than that in control group (53.54 鹵10.87). There was no significant difference in left and right gain between different groups of subjects (p 0.05). There was no significant difference in the phase difference and gain between paroxysmal sleepiness with RBD and those without RBD. There was no significant difference between the two hemispheres before and after treatment. Compared with before and after treatment, ESS(11.3 鹵2.0) was significantly lower than that before and after treatment (ESS(15.6 鹵2.7). The difference of PD between left PD(43.9 鹵12.54 擄and left PD(24.79 鹵10.13 擄after treatment was significantly higher than that before treatment, and the difference was statistically significant (P 0.05). After treatment, the right PD(43.05 鹵14.89 擄PD(43.05 was significantly higher than that of the left side PD(25.39 鹵5.50 擄(P 0.05), but there was no significant difference in left and right gain before and after treatment. Conclusion (1) there is no difference in the degree of impairment of dynamic cerebral blood flow automatic regulation between patients with paroxysmal sleepiness with RBD and those without RBD. There may be the same pathophysiological mechanism related to .t3) the automatic regulation of dynamic cerebral blood flow in patients with narcolepsy was improved after treatment with drugs (methylphenidate, fluoxetine or venlafaxine).
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R740

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