平鼾祛湿汤联合持续气道正压通气治疗阻塞性睡眠呼吸暂停综合征疗效观察

Efficacy of decoction for calming snoring and dispelling dampness combined with continuous positive airway pressure on obstructive sleep apnea syndrome

目的观察平鼾祛湿汤联合持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAS)的临床疗效。方法选择2021年1月—2022年3月河北省沧州中西医结合医院诊治的80例OSAS患者为研究对象,随机分为2组各40例,对照组给予CPAP治疗,观察组在对照组基础上加用平鼾祛湿汤治疗,2组均治疗12周。比较2组治疗前后中医证候积分,呼吸睡眠相关指标[Epworth嗜睡量表评分(ESS评分)、睡眠呼吸暂停低通气指数(AHI)、呼吸紊乱时最低氧饱和度(LSaO 2)、压力滴定值]、体质指数(BMI)、红细胞相关指标[红细胞分布宽度(RDW)、红细胞计数(RBC)、血红蛋白(Hb)、促红细胞生成素(EPO)]及临床治疗效果与不良反应发生情况。结果2组治疗12周后的单项中医症状(形体肥胖、胸脘痞闷、呕恶纳呆、嗜睡、倦怠乏力、大便溏滞不爽、身体困重、痰多色白、头晕健忘)积分与总积分均较治疗前显著降低(P均<0.05),且观察组治疗后的上述积分均显著低于对照组(P均<0.05)。2组治疗12周后的ESS评分、AHI、BMI及RDW、RBC、Hb、EPO水平均显著低于治疗前(P均<0.05),压力滴定值、LSaO 2均显著高于治疗前(P均<0.05),且观察组治疗后的上述指标改善情况均显著优于对照组(P均<0.05)。观察组治疗总有效率为92.5%(37/40),明显高于对照组的70.0%(28/40)(P<0.05)。观察组不良反应发生率为7.5%(3/40),明显低于对照组的22.5%(9/40)(P<0.05)。结论在CPAP基础上加用平鼾祛湿汤治疗OSAS可明显改善患者临床症状和呼吸睡眠情况,且不良反应少,其机制可能与改善红细胞相关指标,降低微循环血液黏稠度,从而改善机体缺氧状况有关。

Objective It is to observe the clinical efficacy of decoction for calming snoring and dispelling dampness combined with continuous positive airway pressure(CPAP)in the treatment of obstructive sleep apnea syndrome(OSAS).Methods Eighty OSAS patients diagnosed and treated in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2021 to March 2022 were selected as the study subjects,and were randomly divided into 2 groups,with 40 cases in each group.The control group was treated with CPAP,and the observation group was treated with decoction for calming snoring and dispelling dampness combined with CPAP,and both groups were treated for 12 weeks.The scores of traditional Chinese medicine syndrome,respiratory and sleep-related indexes[Epworth Sleepiness Scale score(ESS score),apnea hypoventilation index(AHI),LSaO 2,pressure titration value],body mass index(BMI),red blood cell-related indexes[red blood cell distribution width(RDW),red blood cell count(RBC),hemoglobin(Hb),erythropoietin(EPO)]before and after treatment,and clinical outcomes and occurrence of adverse effects were observed and compared in the two groups.Results After 12 weeks of treatment,the scores of each TCM symptom(obesity,chest and epigastric stuffiness,vomiting and nausea,drowsiness,fatigue,loose stools,heavy body,excessive white phlegm,dizziness and forgetfulness)and total scores of the two groups were significantly lower than those before treatment(all P<0.05),and the scores of the observation group were all significantly lower than those of the control group(all P<0.05);the levels of ESS,AHI,BMI and RDW,RBC,Hb and EPO of the two groups were significantly lower,while the pressure titer value,LSaO 2 were all significantly higher than those before treatment(all P<0.05),and the improvements of the above indexes in the observation group after treatment were significantly better than those in the control group(all P<0.05).The total effective rate of treatment in the observation group was 92.5%(37/40),which was significantly higher than that of 70.0%(28/40)in the control group(P<0.05).The incidence rate of adverse reactions in the observation group was 7.5%(3/40),which was significantly lower than that of 22.5%(9/40)in the control group(P<0.05).Conclusion Decoction for calming snoring and dispelling dampness combined with CPAP can significantly improve the clinical symptoms and respiratory sleep condition of the patients with OSAS with few adverse reactions,the mechanism may be related to improving red blood cell-related indexes,reducing microcirculation blood viscosity,thus to improve hypoxia.