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目的探讨经颅多普勒超声(TCD)对阻塞性睡眠呼吸暂停综合征脑血管反应能力的评价。方法40例符合阻塞性睡眠呼吸暂停综合征(OSAS)诊断标准的患者入选试验组,40例健康人作对照组。常规TCD检查后,进入TCDMF-CO2反应监测软件,取双侧大脑中动脉(MCA)作监测血管,经改进的麻醉呼吸气囊接可充气呼吸面罩,使受检者吸入5%CO2和95%O2混合气体1 min诱发高碳酸血症,经过度换气试验诱发低碳酸血症,计算试验前后血流速度变化百分比。结果常规TCD检查发现:试验组中,异常33例(33/40,82.5%),其中血流速度减慢27例(27/40,67.5%),血管狭窄7例(7/40,17.5%);对照组中异常7例(7/40,17.5%),试验组TCD异常检出率显著高于对照组(χ2=48.5,P<0.01)。CO2吸入后,试验组血流速度的增加值和增加率均显著低于对照组(P<0.05、P<0.01);过度换气后,试验组血流速度的下降值和下降率也均显著低于对照组(P<0.05、P<0.01)。结论OSAS患者由于长期缺氧易发生动脉硬化,导致脑血流减低和/或脑动脉狭窄。OSAS患者脑血管的反应能力下降,与其脑内微小动脉血管的硬化有关,同时还存在颅内大血管的狭窄性改变。
Objective To evaluate the evaluation of cerebrovascular responses to obstructive sleep apnea syndrome by transcranial Doppler ultrasound (TCD). Methods Forty patients with diagnostic criteria of obstructive sleep apnea syndrome (OSAS) were enrolled in the test group and 40 healthy people as the control group. TCDMF-CO2 reaction monitoring software was used after conventional TCD examination. The bilateral middle cerebral artery (MCA) was used to monitor the blood vessel. The modified anesthetized respiration airbag was connected to the inflatable respirator so that the subjects inhaled 5% CO2 and 95% O2 Mixed gas 1 min induced hypercapnia, hypoglycaemia induced by hyperventilation test, calculate the percentage change of blood flow velocity before and after the test. Results TCD examination showed that in the test group, 33 cases (33/40, 82.5%) were abnormal, of which 27 cases (27/40, 67.5%) had blood flow slowed down and 7 cases (17/40, 17.5% ). There were 7 cases (7/40, 17.5%) in the control group. The detection rate of abnormal TCD in the test group was significantly higher than that in the control group (χ2 = 48.5, P <0.01). After inhalation of CO2, the increase rate and increase rate of blood flow velocity in the experimental group were significantly lower than those in the control group (P <0.05, P <0.01). After the hyperventilation, the decrease and decrease rate of blood flow velocity in the experimental group were also significant Lower than the control group (P <0.05, P <0.01). Conclusions OSAS patients develop arteriosclerosis due to prolonged hypoxia, resulting in decreased cerebral blood flow and / or cerebral artery stenosis. OSAS patients with decreased ability to respond to cerebrovascular, and its brain microvascular arterial sclerosis, while there are still stenosed intracranial vascular changes.