神经肌肉疾病患者睡眠呼吸障碍特点与干预措施

Characteristics and intervention measures of sleep-disordered breathing in patients with neuromuscular disease

目的:睡眠呼吸障碍在神经肌肉疾病患者中相当普遍,严重影响了患者的生活质量,综述有关神经肌肉病睡眠呼吸障碍的文献,总结神经肌肉疾病患者睡眠呼吸障碍的特点、发病机制及其干预措施。资料来源:应用计算机检索Pubmed和Neurology数据库2000-01/2005-12有关神经肌肉疾病睡眠呼吸障碍方面的文章,检索词“sleep-disorderedbreathing,neuromusculardisease”,并限定文章语言种类为English。资料选择:选取包括神经肌肉疾病睡眠呼吸障碍的特点,治疗进展等相关方面的文献。纳入标准:①设立对照,②临床试验详细介绍了观察参数及结果;综述类的文章被排除在外。资料提炼:共检索88篇关于神经肌肉疾病方面的文章,17篇符合纳入标准,其余71篇或因不涉及睡眠呼吸障碍,或因是综述类、个案报道和护理方面文章故没有采用。资料综合:①睡眠呼吸障碍即睡眠期出现的呼吸暂停或低通气表现。神经肌肉疾病睡眠呼吸障碍最易发生在快眼动相睡眠期,其最常见的表现形式是通气不足。②神经肌肉疾病睡眠呼吸障碍不仅与疾病本身有关还与其他许多可能的机制有关。许多神经肌肉疾病引起睡眠障碍夜间通气不足和慢性呼吸衰竭。③有睡眠呼吸障碍的神经肌肉病患者往往是通过临床来早期诊断的,肺活量的测定是判定呼吸肌无力最简单最快的方法。神经肌肉疾病睡眠呼吸障碍可通过全夜多导睡眠仪确诊。④神经肌肉疾病睡眠呼吸障碍在早期诊断后可通过使用非侵袭性正压通气辅助治疗,改善患者生活质量,延长生命。结论:神经肌肉疾病睡眠呼吸障碍不仅与疾病本身有关还与其他许多可能的机制有关。近5年关于神经肌肉疾病睡眠呼吸障碍特点,发病机制及干预方面均取得了一定进展。弄清楚治疗的对象、时间、长期效果、受益于非创伤性正压通气的生理机制、患者下一次治疗的间隔时间、患者对正压通气的耐受性和顺应性以及对血气异常的长期影响等将是以后尚需进一步研究的内容。

OBJECTIVE： Sleep-disordered breathing is very common in patients with neuromuscular disease, which severely influences the quality of life in patients. To review the literatures about sleep-disordered breathing in neuromuscular disease and summarize the feature, pathogenesis and intervention measures of sleep-disordered breathing in patients with neuromuscular dis- ease. DATA SOURCES： The literatures＇related to sleep-disordered breathing in neuromuscular disease patients published from January 2000 to December 2005were retrieved by computer in Pubmed and Neurology database by using the keywords of ＂sleep-disordered breathing, neuromuscular disease＂, and the language was limited to English. STUDY SELECTION： Articles about the characteristics and management progress of sleep-disordered breathing in patients with neuromuscular disease were selected. Inclusive criteria：①Studies containing control group.② Studies with observation parameter and conclusion in clinical trials. Reviews were excluded. DATA EXTRACTION： A total of 88 articles related to the sleep-disordered breathing of neuromuscular disease were collected, in which 17 were in accordance with the inclusive criteria, and the rest 71 reviews, individual reports, articles without sleep-disordered breathing and studies about nursing were excluded. DATA SYNTHESIS： ①Sleep-disordered breathing was breathing holding or weak breathing in sleep. The sleep-disordered breathing in neuromuscular disease patient was mostly apt to taking place in the rapid eye movement sleep, the common representation of which was hypoventilation.②Sleep-disordered breathing in neuromuscular disease related with both itself and some other possible mechanism. Many neuromuscular diseases caused some sleep disorders such as hypoventilation and chronic respiratory failure. ③Sleep-disordered breathing in patients with neuromuscular disease were usually diagnosed in clinic, and determination of lung capacity Was the most simple method which could judge respiratory amyasthenia quickest. The polysomnogram could be used to finally diagnose sleep-disordered breathing of neuromuscular disease. ④After early diagnosis, the quality of life in patients could be improved, and their life could be prolonged by using noninvasive positive pressure ventilation. CONCLUSION： Sleep-disordered breathing of neuromuscular disease is related with not only the disease itself but also many other possible mechanisms. Certain progresses in characteristics, mechanism and intervention measures have been achieved in the past 5 years. However, more work should be done on subjects, time, long-term effects, physical mechanism profited from noninvasive positive pressure ventilation, interval between each treatment, the toleration and compliance of patients to positive pressure ventilation as well as long-term effects of abnormal blood gas.