经颅多普勒超声对阻塞性睡眠呼吸暂停低通气综合征脑血管反应性的评价

Assessment of cerebrovascular reactivity in obstructive sleep apnea hypopnea syndrome with transcranial Doppler ultrasonography

目的探讨经颅多普勒超声(TCD)评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑血管反应性(CVR)的应用价值。方法选取2015年8月～2016年12月在北京市海淀医院神经内科门诊和病房治疗的OSAHS患者60例作为病例组,又根据呼吸暂停低通气指数(AHI)将患者分为轻度组15例、中度组27例及重度组18例,同期选取20例在本院健康体检者作为对照组。入选者均在入院当日接受TCD检查,检测CVR情况,包括平静呼吸时、屏气后大脑中动脉的平均血流速度(Vm),计算屏气指数(BHI),采用Pearson线性相关分析。结果病例组与对照组平静呼吸时Vm比较,差异无统计学意义[(73.64±9.87)cm/s vs (72.79±8.68)cm/s,P>0.05],病例组屏气后Vm和BHI均低于对照组,差异有统计学意义[(88.63±6.65)cm/s vs (93.26±7.12)cm/s,P<0.05;0.71±0.16 vs 0.93±0.37,P<0.01]。轻度组、中度组和重度组平静呼吸时Vm比较,差异无统计学意义(P>0.05)。轻度组屏气后Vm、BHI均高于中度组和重度组,且中度组高于重度组,差异有统计学意义(P<0.01)。AHI与平静呼吸时Vm无明显相关性(r=0.197,P=0.052),AHI与屏气后Vm和BHI呈负相关(r=-0.557,P=0.011;r=-0.605,P=0.000)。结论 TCD能反映OSAHS患者CVR的变化情况,患者屏气后Vm、BHI明显下降,病情越严重,下降越明显。

Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity (CVR)in obstructive sleep apneahypopnea syndrome (OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015 to December 2016 served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20 healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI) was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis.Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87 cm/s vs 72.79±8.68 cm/s,P>0.05). Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65 cm/s vs 93.26±7.12 cm/s,0.71±0.16 vs 0.93±0.37,P<0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P<0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHI was negatively correlated with Vm after breath holding and BHI(r=-0.557,P=0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.