【摘要】：目的探究急性腦梗死患者阻塞性睡眠呼吸暫停（obstrustive sleep apnea-hypopnea syndrome，OSAHS）的體位特征，為合并OSAHS的腦梗死患者尋找體位干預的理論依據(jù)和臨床干預方法。方法連續(xù)入選經(jīng)頭顱MRI檢查證實并經(jīng)多導睡眠圖(PSG)檢查診斷為急性腦梗死合并OSAHS的患者，根據(jù)PSG結(jié)果，將仰臥位AHI≥其它體位AHI2倍的患者定為體位性OSAHS（positional patientsPP），將仰臥位AHI其它體位AHI2倍的患者定為非體位性OSAHS（non-positional patients NPP）。比較體位性和非體位性OSAHS腦梗死患者的睡眠呼吸紊亂的體位特征、卒中危險因素、臨床特征及頭顱MRI的特征。比較合并OSAHS的腦梗死與非腦梗死患者睡眠呼吸紊亂的體位特征及危險因素。結(jié)果連續(xù)篩查的122腦梗死病例中，67.2%（82/122）合并睡眠呼吸紊亂，其中87.8%（72/82）患者為OSAHS，3.7%（3/82）為中樞性睡眠呼吸紊亂（CSA），8.5%（7/82）的為混合性睡眠呼吸紊亂（MSA）。腦梗死組高血壓、糖尿病、血脂增高和吸煙患者均明顯高于非腦梗死組P0.05。72例合并OSAHS的腦梗死者中體位性OSAHS為58.3%（42/72），其仰臥位AHI為30.70±11.20，仰臥位時間為55.6%，非體位性OSAHS為41.7%（30/72），，仰臥位AHI為19.66±8.9，仰臥位時間45.2%，P0.05。體位性腦梗死組高血壓、高脂血癥和心臟病患病率高于非體位組。首次腦梗死與復發(fā)腦梗死組比較顯示，無論PP組還是NPP組復發(fā)組睡眠呼吸紊亂程度更重。不同部位梗死分析顯示后循環(huán)梗死PP發(fā)生率為75%，前循環(huán)為51%，前后循環(huán)為63.6%，前后循環(huán)比較有顯著性，P0.05。將腦梗死分為腔隙梗死組和非腔隙梗死組后發(fā)現(xiàn)后者PP發(fā)生率高（P=0.047），且更多地采取仰臥位睡眠（P=0.001）。NIHSS分值≥7組PP發(fā)生率為84.6%（11/13），AHI為32.12，仰臥位AHI為35.43，仰臥位時間72.3%，NIHSS7分組PP發(fā)生率為52.5%（31/59），AHI為26.04，仰臥位AHI為29.34，仰臥位時間63.5%(P=0.034)。結(jié)論急性腦梗死患者體位性OSAHS患病率高，卒中復發(fā)率高，梗死面積大，神經(jīng)功能損傷重。早期積極篩查、評估和體位干預有可能改變合并體位性OSAHS腦梗死的轉(zhuǎn)歸。
[Abstract]:Objective to investigate the postural characteristics of obstructive sleep apnea (obstrustive sleep apnea-hypopnea syndrome,OSAHS) in patients with acute cerebral infarction (ACI), and to find the theoretical basis and clinical intervention method for postural intervention in patients with cerebral infarction complicated with OSAHS. Methods patients with acute cerebral infarction complicated with OSAHS confirmed by cephalic MRI and diagnosed by polysomnography (PSG) were enrolled in this study. According to the results of PSG, the patients with AHI 鈮

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