祛瘀化痰汤联合无创正压通气法治疗痰湿型中重度阻塞性睡眠呼吸暂停低通气综合征临床研究

Clinical observation on Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type

目的评价祛瘀化痰汤联合无创正压通气法治疗痰湿型中重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)的疗效。方法将符合入选标准的64例痰湿型OSAHS患者按随机数字表法分为2组,每组32例。对照组采用无创正压通气法治疗,观察组在对照组基础上加服祛瘀化痰汤。2组均连续治疗4周。采用导睡眠分析诊断系统记录患者治疗前后口鼻气流、血氧饱和度(oxygen saturation,SaO2)、胸腹运动等,计算睡眠呼吸暂停低通气指数(apnoea-hypopnoea index,AHI)、夜间最低SaO2、脉压(pulse pressure,PP)及最长呼吸暂停时间变化;采用埃普沃思嗜睡量表(Epworth Sleepiness Scale,ESS)评估嗜睡程度,采用匹茨堡睡眠指数(Pittsburgh Sleep Quality Index,PSQI)评估睡眠质量,采用Calgary睡眠呼吸暂停生活质量指数(the Calgary Sleep Apnea Quality of Life Index,SAQLI)评估生活质量,评价临床疗效。结果观察组总有效率为87.5%(28/32)、对照组为68.8%(22/32),2组比较差异有统计学意义(Z=-3.187,P=0.000);治疗后,观察组AHI[(8.59±0.93)次/h比(18.62±2.44)次/h,t=5.735]、PP[(35.96±4.02)mmHg比(43.33±4.70)mmHg,t=5.083]、最长呼吸暂停时间[(11.93±1.86)s比(17.94±2.43)s,t=4.863]均低于对照组(P<0.05),夜间最低SaO2[(93.07±10.03)%比(82.36±9.37)%,t=5.812]高于对照组(P<0.05);观察组ESS评分[(5.53±0.33)分比(8.73±0.96)分,t=4.682]、PSQI评分[(2.25±0.31)分比(5.68±0.77)分,t=4.872]均低于对照组(P<0.05),SAQLI评分[(6.12±0.59)分比(4.36±0.53)分,t=4.631]高于对照组(P<0.05)。结论祛瘀化痰汤联合无创正压通气法可改善痰湿型中重度OSAHS患者的睡眠呼吸障碍,缓解嗜睡症状,提高睡眠及生活质量。

Objective To observe the clinical effect of Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type.Methods A total of 64 patients with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type were divided into observation group and control group according to the random number table method,with 32 cases in each group.The control group received routine clinical treatment combined with noninvasive positive pressure ventilation,while the observation group was treated with Quyu-Huatan decoction on the basis of the control group.After 4 weeks of treatment,the polysomnography(PSG)index(the apnea hypopnea index,AHI,the Oxygen saturation,SaO2,the pulse pressure,PP,the longest apnea time),the degree of lethargy(Epworth sleepiness scale,ESS),the quality of sleep(Pittsburgh sleep quality index,PSQI)and the quality of life(Calgary mass index of life quality index,SAQLI)before and after the treatment of two groups were observed,and the clinical effect was compared.Results The total effective rate of the observation group was 87.5%(28/32),which was significantly higher than that 68.8%(22/32)of the control group(Z=-3.187,P=0.000).After treatment,the AHI(8.59±0.93 times/h vs.18.62±2.44 times/h,t=5.735),the PP(35.96±4.02 mmHg vs.43.33±4.70 mmHg,t=5.083)and the longest apnea time(11.93±1.86 s vs.17.94±2.43 s,t=4.863)of the observation group were significant lower than those of the control group(P<0.05),while the SaO2 content(93.07%±10.03%vs.82.36%±9.37%,t=5.812)of the observation group were significant higher than those of the control group(P<0.05).After treatment,the ESS(5.33±0.33 vs.8.73±0.96,t=4.682)and the PSQI(2.25±0.31 vs.5.68±0.77,t=4.872)of the observation group were significant lower than those of the control group(P<0.05),and the SAQLI(6.12±0.59 vs.4.36±0.53,t=4.631)of the observation group were significant higher than those of the control group(P<0.05).Conclusions The application of Quyu-Huatan decoction combined with noninvasive positive pressure ventilation in treatment with moderate to severe obstructive sleep apnea hypopnea syndrome with phlegm dampness type can improve sleep disordered breathing,relieve drowsiness,and improve sleep quality and quality of life.