抗反流药物联合气道正压通气治疗OSAHS伴胃食管反流疗效观察

The therapeutic effect of antireflux medicine combined with positive airways pressure on obstructive sleep apnea-hypopnea syndrome with gastroesophageal reflux

目的探讨抗反流药物联合经鼻持续气道正压通气(nCPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴胃食管反流(GER)的疗效。方法对80例中重度OSAHS伴GER的患者行多导睡眠图(PSG)和食管pH同步监测后,随机分为两组,每组各40例。对照组给予单纯抗反流药物治疗,口服埃索美拉唑40 mg/d,枸橼酸莫沙必利5 mg,3次/天;治疗组在对照组基础上联合每晚的nCPAP治疗。两组均于治疗第3、7天观察OSAHS症状及GER症状的改善情况,并于第7晚重复PSG和食管pH同步监测。结果与对照组相比,治疗组治疗第3天、第7天的OSAHS症状改善率及治疗第3天的GER症状改善率均明显提高,差异有统计学意义(P<0.05),治疗第7天的GER症状改善率差异无统计学意义(P>0.05),治疗组治疗第7晚时的呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、pH<4时间百分比、最长反流时间、反流次数及DeMeester评分均与对照组比较差异有统计学意义(P<0.05)。结论 OSAHS伴GER患者使用抗反流药物联合nCPAP能使治疗全面、快速、充分、安全。

Objective To investigate the therapeutic effect of antireflux medicine combined with nasal continuous positive airways pressure（nCPAP） on obstructive sleep apnea-hypopnea syndrome（OSAHS） with gastroesophageal reflux（GER）.Methods 80 patients with moderate to severe OSAHS with GER were simultaneously received polysomnography（PSG） and esophageal PH monitoring and randomly divided into control group and treatment group with each group 40 patients.The control group were simply received antireflux medicine,with esomeprazole 40mg/d and mosapride citrate 5 mg,3 times a day,oral.The treatment group were received the same treatment and combined with nCPAP for everynight.Both the groups′ symptomatic status of OSAHS and GER were observed on the third day and the 7th day during therapy,and then the same tests above were repeated on the 7th day.Results Compared with the control group,the symptomatic improvement rate of OSAHS on the third day and 7th day during therapy,the symptomatic improvement rate of GER on the third day during therapy were increased with statistical significance in the treatment group（P0.05）,however,the difference of symptomatic improvement rate of GER between the two groups on the 7th day during therapy didn′t have statistical significance（P0.05）.Compared with those of the control group on the 7th therapeutic night,AHI,LSaO2,the percentage of time with pH4,the longest reflux duration,reflux episodes and DeMeester scoring had statistical significance in the treatment group（P0.05）.Conclusion Simple antireflux medicine has limited therapeutic effect on OSAHS with GER,but combined with nCPAP may be a more effective,fast,sufficient and safe method for OSAHS with GER.