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目的探讨膈神经传导时间(PNCT)和膈肌复合肌肉动作电位(CMAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者严重程度的评估和疗效判定的意义。方法 2005年1至7月选择健康对照组16例、单纯性鼾症组8例、OSAHS 轻中度组14例和重度组18例,使用多导食道电极结合单侧膈神经磁刺激测定 PNCT 及膈肌 CMAP 幅值。5例 OSAHS 重度患者通过有效经鼻持续气道正压通气(nCPAP)治疗2个月后复查上述指标。结果 OSAHS 重度组左、右侧 PCNT 分别为(8.9±1.2)、(7.9±1.5)ms,较健康对照组的(6.5±0.7)、(6.0±0.5)ms、单纯性鼾症组的(6.5±1.2)、(6.0±0.8)ms 及 OSAHS 轻中度组的(7.3±1.0)、(6.3±0.7)ms 均显著延长;双侧 CMAP 幅值OSAHS 轻中度组分别为(1.4±0.4)、(1.4±0.3)mV,OSAHS 重度组分别为(0.9±0.4)、(1.1±0.6)mV,较健康对照组的(2.3±0.9)、(2.1±0.9)mV 和单纯性鼾症组的(1.9±0.5)、(2.1±0.7)mV 均明显降低,OSAHS 重度组双侧 CMAP 较轻中度组显著降低。所有受试者双侧 PNCT 和 CMAP 与低氧指数、睡眠呼吸暂停低通气指数均有显著相关性。有效 nCPAP 治疗2个月后,双侧 PNCT 较治疗前均显著缩短,左侧分别为(8.6±0.6)ms、(7.4±0.5)ms,右侧分别为(7.8±0.6)ms、(6.5±0.5)ms。结论由多导食管电极和单侧膈神经刺激检测的 PNCT 和 CMAP 可能对评价 OSAHS 患者的严重程度和疗效判定有一定价值。
Objective To evaluate the significance of the evaluation of the severity of obstructive sleep apnea-hypopnea syndrome (OSAHS) by phrenic nerve conduction time (PNCT) and diaphragm combined muscle action potential (CMAP) and the significance of the curative effect. Methods From January to July 2005, 16 cases of healthy control group, 8 cases of simple snoring group, 14 cases of mild and moderate OSAHS group and 18 cases of severe group were enrolled in this study. PNCT was detected by multi-channel esophageal electrode combined with unilateral phrenic nerve stimulation Diaphragm CMAP amplitude. Five patients with severe OSAHS were followed up for 2 months after treatment with effective nasal continuous positive airway pressure (nCPAP). Results The PCNT of left and right OSAHS group were (8.9 ± 1.2) and (7.9 ± 1.5) ms, respectively, which were significantly higher than those of healthy control group (6.5 ± 0.7 and 6.0 ± 0.5) ms and 6.5 ± 1.2, 6.0 ± 0.8, and 7.3 ± 1.0, 6.3 ± 0.7 ms in OSAHS mild and moderate groups respectively. The bilateral mild and moderate CMAP OSAHS scores were (1.4 ± 0.4) , (1.4 ± 0.3) mV and (0.9 ± 0.4) and (1.1 ± 0.6) mV in severe OSAHS group compared with those in healthy control group (2.3 ± 0.9), (2.1 ± 0.9) mV and simple snoring group (1.9 ± 0.5), (2.1 ± 0.7) mV were significantly lower in OSAHS severe group bilateral mild and moderate CMAP group was significantly lower. Bilateral PNCT and CMAP were significantly correlated with hypoxia index and sleep apnea-hypopnea index in all subjects. After two months of effective nCPAP treatment, bilateral PNCTs were significantly shorter than before treatment, with (8.6 ± 0.6) ms and (7.4 ± 0.5) ms on the left and (7.8 ± 0.6) ms and (6.5 ± 0.5) ms. Conclusions PNCT and CMAP detected by multi-guide esophageal electrodes and unilateral phrenic nerve stimulation may be of value in evaluating the severity and efficacy of OSAHS.