摘要
目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者整夜睡眠前后和有效经鼻持续气道正压通气治疗前后膈肌肌电图的变化。方法对22例中重度OSAHS患者和24例正常受试者使用胸壁表面电极记录膈肌肌电图，分别测定睡眠前后由单侧膈神经磁刺激（UMS）诱发的膈神经传导时间（PNCT）及膈肌联合肌肉动作电位（CMAP），5例重度OSAHS患者经过有效经鼻持续气道正压通气治疗超过2个月后再次测定上述指标。结果OSAHS患者与正常受试者比较，整夜睡眠前、后双侧PNCT显著延长[左侧：（8．4±0．6）ms、（8．4±0．9）ms与（7．3±0．8]ms、（7．3±0．8）ms；右侧：（8．4±1．3）ms、（8．9±0．8）ms与（7．2±0．8）ms、（7．2±0．8）ms，均P〈0．01）；双侧CMAP幅值显著降低[左侧：（0．60±0．20）mV、（0．64±0．29）mV与（0．98±0．28）mV、（0．97±0．27）mV；右侧：（0．53±0．23）mV、（0．56±0．26）mV与（0．93±0．29）mV、（0．94±0．29）mV，均P〈0．01]；两组受试者入睡前与睡眠后比较，双侧PNCT及CMAP差异均无统计学意义（均P〉0．05）。5例重度OSAHS患者经有效经鼻持续气道正压通气治疗超过2个月后，双侧PNCT较治疗前显著缩短[左侧为（8．6±0．7）ms与（7．4±0．5）ms，右侧为（7．8±0．6）ms与（6．4±0．6）ms，均P〈0．05]。结论OSAHA患者膈神经传导和膈肌功能减弱，可能与长期夜间缺氧和（或）睡眠结构紊乱有关。
Objective To explore change of diaphragm electromyograms in patients with obstructive sleep apnea-hypoventilation syndrome （OSAHS） before and after nocturnal sleep, as well as effective nasal continuous positive airway pressure （n-CPAP） ventilation treatment for more than two months. Methods Diaphragm electromyogram was recorded with chest surface electrodes in 22 patients with moderate and severe OSAHS and 24 normal people, and phrenic nerve conduction time （PNCT） and diaphragm compound muscle action potential （CMAP） provoked by unilateral magnetic stimulation （UMS） were measured for them before and after sleep. Measurements were repeated for five patients with severe OSAHS after effective n-CPAP ventilation treatment for more than two months. Results ① PNCT was significantly longer in OSAHS patients before and after nocturnal sleep than that in normal people bilaterally, （8.4 ± 0. 6） ms and （8.4 ± 0. 9） ms vs （7.3 ± 0. 8 ） ms and （7.3 ± 0. 8 ） ms for the left side ; and （ 8.4 ± 1.3 ） ms and （ 8. 9 ± 0. 8）ms vs （7.2 ± 0. 8）ms and （7.2 ±0. 8）ms for the right side （P 〈0. 01 ）, respectively; and amplitude of CMAP was significantly lower in OSAHS patients, （0. 60 ± 0. 20）mV and （0. 64 ± 0. 29 ）mV vs （0. 98 ± 0. 28）mV and （0. 97 ±0. 27）mV for the left side; and （0. 53 ±0. 23）mV and （0. 56 ±0. 26）mV vs （0. 93 ±0. 29） mV and （ 0. 94 ± 0. 29 ） mV for the right side, respectively （ P 〈 0. 01 ） ; but no significant difference in amplitude of CMAP was found before and after nocturnal sleep （ P 〉 0. 05 ）. ② PNCT was significantly shortened bilaterally in five patients with severe OSAHS after effective n-CPAP ventilation treatment for more than two months, （8.6 ±0. 7）ms vs （7.4 ±0. 5）ms for the lfet side and （7.8 ±0. 6）ms vs （6.4 ±0. 6）ms for the right side （P 〈0.05）, respectively. Conclusions Both phrenic nerve conduction and diaphragm muscle function are weakened in patients with OSAHA, which may be related to hypoxia and/ or disturbance of sleep structure at night.
出处
《中华全科医师杂志》
2009年第1期18-21,共4页
Chinese Journal of General Practitioners
关键词
睡眠呼吸暂停
阻塞性
膈神经
膈肌肌电图
Sleep apnea, obstructive
Phrenic nerve
Diaphragm electromyogram
