电针联合口肌生物反馈系统训练治疗脑卒中后重度阻塞性睡眠呼吸暂停的临床疗效

Clinical Effect of Electric Acupuncture Therapy Combined with Oral Muscle Biofeedback System Training on Post-stroke Severe OSA

目的观察电针联合口肌生物反馈系统训练治疗脑卒中后重度阻塞性睡眠呼吸暂停(OSA)的临床疗效。方法选取2017年常州市德安医院康复中心收治的脑卒中后重度OSA患者56例,采用随机数字表法分为对照组与观察组,每组28例。在常规治疗与康复训练基础上,对照组患者针对OSA采用持续气道正压通气(CPAP)治疗,观察组患者针对OSA采用电针联合口肌生物反馈系统训练,两组患者均连续治疗6周,治疗后随访3个月。比较两组患者治疗前、治疗1周、治疗3周、治疗6周及随访3个月呼吸暂停低通气指数(AHI)和Epworth嗜睡量表(ESS)评分,治疗前及治疗6周血清炎性因子水平,并观察两组患者治疗期间不良反应发生情况。结果时间与方法在AHI上存在交互作用(P<0.05);时间与方法在AHI上主效应显著(P<0.05);观察组患者治疗1、3周AHI高于对照组,随访3个月AHI低于对照组(P<0.05)。时间与方法在ESS评分上存在交互作用(P<0.05);时间与方法在ESS评分上主效应显著(P<0.05);随访3个月观察组患者ESS评分低于对照组(P<0.05)。治疗前两组患者血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、基质金属蛋白酶9(MMP-9)、超敏C反应蛋白(hs-CRP)水平比较,差异无统计学意义(P>0.05);治疗6周观察组患者血清TNF-α、IL-6、MMP-9、hs-CRP水平低于对照组(P<0.05)。两组患者治疗期间均未发生明显不良反应。结论电针联合口肌生物反馈系统训练能有效减轻脑卒中后重度OSA患者睡眠呼吸暂停程度,但起效较慢,此外还可改善患者睡眠状态、减轻炎性反应,且安全性较高。

Objective To observe the clinical effect of electric acupuncture therapy combined with oral muscle biofeedback system training on post-stroke severe OSA. Methods In 2017,a total of 56 patients with post-stroke severe OSA were selected in the Rehabilitation Center,Dean Hospital of Changzhou,and they were divided into control group and observation group according to random number table,each of 28 cases. Based on conventional treatment and rehabilitation training,patients in control group received continuous positive airway pressure ventilation,while patients on observation group received electric acupuncture therapy combined with oral muscle biofeedback system training;both group continuously treated for 6 weeks and followed up by 3 months after treatment. AHI and ESS score before treatment,1 week,3 weeks and 6 weeks after treatment,at the end of 3-month follow-up,serum inflammatory cytokines levels before treatment and 6 weeks after treatment were compared between the two groups,meanwhile incidence of adverse reactions was observed during treatment. Results There was significant interaction between time and method in AHI（P〈0.05）;main effects of time and method were significant in AHI（P〈0.05）;AHI in observation group was statistically significantly higher than that in control group 1 week and 3 weeks after treatment,respectively,while AHI in observation group was statistically significantly lower than that in control group at the end of 3-month follow-up（P〈0.05）. There was significant interaction between time and method in ESS score（P〈0.05）;main effects of time and method were significant in ESS score（P〈0.05）;ESS score in observation group was statistically significantly lower than that in control group at the end of 3-month follow-up（P〈0.05）.No statistically significant differences of serum level of TNF-α,IL-6,MMP-9 or hs-CRP was found between the two groups before treatment（P〈0.05）,while serum levels of TNF-α,IL-6,MMP-9 and hs-CRP in observation group were statistically significantly lower than those in control group 6 weeks after treatment（P〈0.05）. No one in the two groups occurred any obvious adverse reactions during treatment. Conclusion Electric acupuncture therapy combined with oral muscle biofeedback system training can effectively relieve the severity of sleep apnea in patients with post-stroke severe OSA,but the initial effect time is relatively long,besides it is helpful to improve the sleep state and relieve the inflammatory reaction,with relatively high safety.