耳穴贴压治疗阻塞性睡眠呼吸暂停(英文)

Auricular acupoint pressing therapy in the treatment of obstructive sleep apnea syndrome

背景:目前,治疗阻塞性睡眠呼吸暂停综合征的常见方法为悬壅垂咽腭成形术治疗和经鼻持续正压通气治疗。手术治疗有效率为50%,且远期疗效逐渐下降;呼吸机治疗,有一部分患者难以适应。目的:观察耳穴贴压疗法对阻塞性睡眠呼吸暂停综合征临床指标的影响及临床疗效,分析其可能的机制。设计:随机对照观察。单位:河北医科大学第二医院针灸科,呼吸科。对象:阻塞性睡眠呼吸暂停患者45例为2001-04/2004-04在河北医科大学第二医院呼吸科门诊就诊,在呼吸科睡眠监测室确诊患者,男44例,女1例,随机数字表法分为治疗组30例,对照组15例。方法:①治疗组采用耳穴贴压治疗法,取穴:神门、交感、皮质下、心、肺、脾、肾、垂前。每天按压3～5次,每次每穴按压10～20下,10d为1个疗程。对照组给予安慰剂治疗,维生素C100mg口服,3次/d。治疗组与对照组患者治疗前及治疗10d后进行夜间7h多导睡眠图监测,评定疗效。②临床症状疗效标准:显效:头晕、嗜睡、胸憋闷、堵塞等临床症状明显好转;夜尿次数由原来的四五次减少到1次或消失,夜间憋醒次数由原来的四五次减少到1次或消失。有效:临床症状好转。无效:临床症状无改善。主要观察指标:观察治疗前后的临床症状变化及多导睡眠监测仪测定的低通气指数、暂停指数、呼吸紊乱指数、最低血氧饱合度和最长呼吸暂停时间。结果:阻塞性睡眠呼吸暂停综合征患者45例,全部进入结果分析,无脱失。①耳穴贴压治疗组与对照组比较,临床症状明显改善,治疗组,显效17例(56.7%),有效12例(40.0%),无效1例(3.3%)。对照组治疗前后临床症状无改善,治疗组与对照组比较差异有显著性意义(P<0.05)。②PSG监测各项指标比较,耳穴贴压治疗组与对照组治疗后比较差异有显著性意义(P<0.001)。对照组治疗前与治疗后比较差异无显著性意义(P>0.05)。③耳穴贴压治疗组治疗后,暂停指数、呼吸紊乱指数、低通气指数、最低血氧饱和度、最长呼吸暂停时间较治疗前差异有非常显著性意义[(65.25±7.44),(53.69±10.80)次/h;(72.40+7.92),(59.22±10.55)次/h;(9.46±2.6),(6.5±2.9)次/h;(73.3±4.8)%,(77.67±3.78)%;(90.16±33),(45.33±24.69)s,P<0.001]。其中,暂停指数最多下降19.3次/h,呼吸紊乱指数最多下降17.8次/h,低通气指数最多下降10.9次/h,最低血氧饱合度最多上升7%。结论:耳穴贴压疗法治疗阻塞性睡眠呼吸暂停综合征,明显改善低通气指数、暂停指数、呼吸紊乱指数、最低血氧饱合度和最长呼吸暂停时间,疗效良好。

BACKGROUND： At present, common therapies of obstructive sleep apnea syndrome （OSAS） are uvulo-palato-pharyngoplasty and nasal continuous positive airway pressure （N-CPAP）. The effective rate of surgical treatment was 50% and the prostecdtive efficacy is decreased gradually. As to treatment with breathing machine, some of the patients can not adapt to it. OBJECTIVE： To investigate the effects of auricular acupoint pressing therapy on clinical indexes of patients with OSAS and its clinical effect, and analyze the possible mechanism. DESIGN： Randomized control observation. SETTING： Department of Acupuncture and Department of Respiration, Second Hospital of Hebei Medical University. PARTICIPANTS： Forty-five outpatients with OSAS between April 2001 and April 2004, who were diagnosed as OSAS in the room of sleep-monitoring of Department of Respiration, were selected from the Clinic of Respiration, Second Hospital of Hebei Medical University, including 44 males and one female. All subjects were randomly divided into treatment group （n=30） and control group （n=15）. METHODS： ①Patients in the treatment group were treated by auricular acupoint pressing therapy, acupoint-locating： shenmen, sympathesis, subcorrex, heart, lung, spleen, kidney, anterior ear lobe. Each acupoint was pressed about 10-20 times with 3-5 times every day and 10 days as one course. Patients in the control group were treated with placebo and orally took 100 mg of Vitamin C three times a day. Patients in both groups were detected by 7- hour nocturnal polysomnography before treatment and 10 days after the treatment, and the curative effects were evaluated.②Criteria of the curative effects on clinical symptoms： Effective： clinical symptoms such as dizzy, somnolence, oppressed chest and obstructing etc. were significantly ameliorated with nocturnal times decreased from 4-5 times to once or none and awake times decreased from 4-5 to once or none. Valid： clinical symptoms were improved. Invalid： no amelioration was found in clinical symptoms. MAIN OUTCOME MEASURES： Changes of clinical symptoms before and after the treatment and hypopnea index （HI）, apnea index （AI）, apnea hypopnea index （AHI）, minimum blood oxygen saturation as well as the longest apnea time detected by polysomnography were observed. RESULTS： A total of 45 patients with OSAS were involved in the analysis of results, and no one withdrew from the study.①The clinical symptoms in auricular acupoint treatment group were significantly ameliorated than control group. In the treatment group, 17 patients were effective （56.7%）, 12 patients were valid and one patient was invalid. The clinical symptoms in the control group were not improved before and after the treatment, and there were significant differences between the treatment group and control group （P 〈 0.05）.②Comparison in each inspecting indexes by polysomnogram： those in the auricular pressing therapy group were remarkably different from those in the control group after treatment （P 〈 0.001）. There was no significant difference in all indexes of the control group between and after the treatment （P 〉 0.05）.③The differences in AI, HI, AHI, minimum blood oxygen saturation as well as the longest apnea time of the auricular pressing treatment group after the treatment were markedly different from those before treatment [（65.25±7.44）, （53.69±10.80） times/hour; （72.40±7.92）, （59.22±10.55） times/hour; （9.46±2.6）, （6.5±2.9） times/hour; （73.3±4.8）%,（77.67±3.78）% ; （90.16±33）, （45.33±24.69） s,P 〈 0.001]. Among them, the maximum decrease of AI was 19.3 times/hour, the maximum decrease of AHI was 17.8 times/hour, the maximum decrease of HI was 12.9 times/hour and the maximum increase of blood oxygen saturation was 7% . CONCLUSION： Auricular acupoint pressing therapy, in the treatment of OSAS, can significantly ameliorate the AI, HI, AHI, minimum blood oxygen saturation as well as the longest apnea time with better curative effects.