海马益智散对缺血性脑卒中伴阻塞性睡眠呼吸暂停综合征患者认知功能与睡眠结构的影响

Effect of Haima Yizhi Powder on Cognitive Function and Sleep Structure in Patients with Ischemic Stroke Complicated with Obstructive Sleep Apnea Syndrome

目的:观察在常规疗法基础上加用海马益智散对缺血性脑卒中伴阻塞性睡眠呼吸暂停综合征(OSAS)患者认知功能、睡眠结构的作用及对血清半胱氨酸天冬酶(caspase)-3和caspase-9水平的影响。方法:选取90例缺血性脑卒中伴OSAS患者,按随机数字表法分为治疗组和对照组各45例。2组均予经鼻持续气道正压通气和脑卒中常规疗法,治疗组加予海马益智散治疗。2组均连续治疗3个月。比较2组治疗前后的蒙特利尔认知量表(Mo CA)评分、简易智能精神状态检查量表(MMSE)评分、睡眠结构。检测2组治疗前后的血清caspase-3和caspase-9水平。结果:治疗后,2组MoCA评分和MMSE评分均较治疗前升高(P<0.01),治疗组MoCA评分和MMSE评分均高于对照组(P<0.01)。2组Ⅰ期睡眠时间、觉醒时间均较治疗前缩短,Ⅰ期睡眠比率、觉醒次数均较治疗前降低和减少,Ⅱ期睡眠时间、Ⅱ期睡眠比率均较治疗前增加,差异均有统计学意义(P<0.01)。治疗组Ⅰ期睡眠比率低于对照组,Ⅰ期睡眠时间、觉醒时间均较对照组缩短,觉醒次数少于对照组,Ⅱ期睡眠时间长于对照组,Ⅱ期睡眠比率高于对照组,差异均有统计学意义(P<0.01)。2组血清caspase-3和caspase-9水平均较治疗前降低(P<0.01)。治疗组血清caspase-3和caspase-9水平均低于对照组(P<0.01)。结论:在常规疗法基础上加用海马益智散,可明显改善脑卒中伴OSAS患者的认知功能和睡眠结构,下调血清caspase-3和caspase-9水平可能是其疗效途径之一。

Objective:To observe the effect of additional application of Haima Yizhi powder based on the routine therapy on the cognitive function and the sleep structure in patients with ischemic stroke complicated with obstructive sleep apnea syndrome(OSAS),and its effect on the levels of caspase-3 and caspase-9 in serum.Methods:A total of 90 cases of patients with ischemic stroke complicated with OSAS were divided into the treatment group and the control group according to the random number table method,45 cases in each group.Both groups were treated with the nasal continuous positive airway pressure and the routine therapy for ischemic stroke,and the treatment group was additionally treated with Haima Yizhi powder.Both groups were treated for three months.Before and after treatment,the scores of the Montreal Cognitive Assessment(Mo CA) and the Mini-Mental State Examination(MMSE) as well as the sleep structure in the two groups were compared,the levels of caspase-3 and caspase-9 in serum in the two groups were detected.Results:After treatment,the scores of Mo CA and MMSE in the two groups were increased when compared with those before treatment(P<0.01),and the above scores in the treatment group were higher than those in the control group(P<0.01).In the two groups,the sleeping time and the awakening time at stage Ⅰ were shortened when compared with those before treatment;the sleep efficiency and the number of awakenings at stage Ⅰ were decreased when compared with those before treatment;the sleeping time and the sleep efficiency at stage Ⅱ were increased when compared with those before treatment;differences being significant(P<0.01).In the treatment group,the sleep efficiency at stage Ⅰ was lower than that in the control group,while the sleeping time and the awakening time at stage Ⅰ were shorter than those in the control group,and the number of awakenings at stage Ⅰ was less than that in the control group;the sleeping time at stage Ⅱ was longer than that in the control group,and the sleep efficiency at stage Ⅱ was higher than that in the control group,differences being significant(P<0.01).The levels of caspase-3 and caspase-9 in serum in the two groups were decreased when compared with those before treatment(P<0.01).The levels of caspase-3 and caspase-9 in serum in the treatment group were lower than those in the control group(P<0.01).Conclusion:The therapy of Haima Yizhi powder based on routine therapy can significantly improve the cognitive function and the sleep structure in patients with ischemic stroke complicated with OSAS,and one of its mechanisms may be the down-regulation of the levels of caspase-3 and caspase-9 in serum.