针刺治疗脑卒中合并睡眠呼吸暂停低通气综合征随访分析

Follow-up Study on Acupuncture in Treating Stroke Comorbid with Sleep Apnea Hypoventilation Syndrome

目的观察分析针刺廉泉对脑卒中合并睡眠呼吸暂停低通气综合征的近、远期临床疗效。方法符合诊断的30例患者采用针刺廉泉穴治疗,治疗前和治疗4星期后进行睡眠监测、ESS嗜睡量表、NIHSS卒中量表评价,治疗2年后进行ESS嗜睡量表评价以及相关临床症状随访,观察临床疗效。结果完成观察21例,9例脱落。21例脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的患者,针刺加电针治疗后呼吸暂停指数明显下降(P<0.05),睡眠时最低血氧饱和度值明显上升(P<0.05),ESS嗜睡量表评价分数明显下降(P<0.05)。NIHSS卒中量表评价分数无明显改善(P>0.05)。2年后随访21例,完成16例,脱落5例,16例脑卒中合并阻塞性睡眠呼吸暂停低通气综合征的患者,2年后ESS嗜睡量表评价分数较之治疗前无明显改善(P>0.05),较之治疗后4星期也无明显改善(P>0.05)。结论针刺廉泉治疗脑卒中合并阻塞性睡眠呼吸暂停低通气综合征,可降低患者呼吸暂停AHI指数,提高睡眠时最低血氧饱和度,改善临床症状。2年后随访,远期疗效不明显。

Objective To observe and analyze the short-term and long-term clinical effects of acupuncture in treating stroke comorbid with sleep apnea hypoventilation syndrome（SAHS） by needling Lianquan（CV 23）.Methods Thirty patients were enrolled to accept acupuncture at acupoint Lianquan（CV 23）.Sleep monitoring,Epworth Sleepiness Scale（ESS） and the National Institutes of Health Stroke Scale（NIHSS） were adopted for evaluating the therapeutic effects prior to treatment and after 4-week treatment.Two years after the treatment,a follow-up study was conducted to evaluate the ESS and the related symptoms.Result Twenty-one patients finished the whole treatment,while 9 cases failed.Of the 21 patients with stroke comorbid with obstructive sleep apnea hypoventilation syndrome（OSAHS）,the apnea-hypopnea index（AHI） had a notable reduction after electroacupuncture treatment（P0.05）,the lowest oxygen saturation（LOS） during sleep increased significantly（P0.05）,and the ESS score declined markedly（P0.05）,while the NIHSS score did not gain significant improvement（P0.05）.2 years later,of the 21 patients,16 finished the follow-up study,while 5 failed.Among the 16 patients who had stroke comorbid with OSAHS,the follow up study did not show a significant difference in the ESS score compared with the pre-treatment and post-treatment scores（P0.05）.Conclusion In the treatment of stroke comorbid with OSAHS,acupuncture at Lianquan（CV 23） lowers the AHI,enhance the LOS during sleep,and also improves clinical symptoms.However,regarding to the follow-up study conducted 2 years later,the long-term effect is not significant.