阻塞性睡眠呼吸暂停综合症的观察及护理

通过对55例阻塞性睡眠呼吸暂停综合症患者术前、术后的护理及观察，总结了护理体会，着重对术前、术后健康教育及心理、术后伤口出血情况，气管切开护理，咽部水肿，饮食及口腔清洁，并发症观察护理进行了总结，并通过术前，术后血氧饱和度、呼吸、心率的监测，总结了阻塞性睡眠呼吸暂停综合症患者的手术疗效。     

Assessment of Cardiorespiratory Interactions during Apneic Events in Sleep via Fuzzy Kernel Measures of Information Dynamics

Apnea and other breathing-related disorders have been linked to the development of hypertension or impairments of the cardiovascular, cognitive or metabolic systems. The combined assessment of multiple physiological signals acquired during sleep is of fundamental importance for providing additional insights about breathing disorder events and the associated impairments. In this work, we apply information-theoretic measures to describe the joint dynamics of cardiorespiratory physiological processes in a large group of patients reporting repeated episodes of hypopneas, apneas (central, obstructive, mixed) and respiratory effort related arousals (RERAs). We analyze the heart period as the target process and the airflow amplitude as the driver, computing the predictive information, the information storage, the information transfer, the internal information and the cross information, using a fuzzy kernel entropy estimator. The analyses were performed comparing the information measures among segments during, immediately before and after the respiratory event and with control segments. Results highlight a general tendency to decrease of predictive information and information storage of heart period, as well as of cross information and information transfer from respiration to heart period, during the breathing disordered events. The information-theoretic measures also vary according to the breathing disorder, and significant changes of information transfer can be detected during RERAs, suggesting that the latter could represent a risk factor for developing cardiovascular diseases. These findings reflect the impact of different sleep breathing disorders on respiratory sinus arrhythmia, suggesting overall higher complexity of the cardiac dynamics and weaker cardiorespiratory interactions which may have physiological and clinical relevance.     

糖皮质激素受体蛋白在OSAHS患儿腺样体和扁桃体中的表达及临床意义

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿腺样体及扁桃体组织中糖皮质激素受体（GR）α和β蛋白的表达情况及临床意义。方法收集103例中重度OSAHS患儿的腺样体组织,69例中重度OSAHS患儿的扁桃体组织,20例成人慢性鼻咽炎鼻咽部组织,13例成人慢性扁桃体炎扁桃体组织,应用免疫组化SP法检测腺样体、扁桃体和鼻咽部组织中GRα和GRβ蛋白的表达情况,并作比较分析。结果所有的腺样体、扁桃体、鼻咽部组织中均存在不同程度的GRα和GRβ蛋白表达,在腺样体组织中GRα呈高表达,在扁桃体、鼻咽部组织中GRβ呈高表达。在伴或不伴过敏性鼻炎,伴或不伴慢性鼻窦炎,伴或不伴分泌性中耳炎的OSAHS患儿间比较,其腺样体和扁桃体组织中GRα、GRβ蛋白表达及GRα/GRβ均无统计学差异（均P＞0.05）。中、重度OSAHS患儿间比较,腺样体、扁桃体组织GRα、GRβ蛋白表达及GRα/GRβ均无统计学差异（均P＞0.05）。Ⅱ、Ⅲ度扁桃体肥大的OSAHS患儿间比较,扁桃体组织GRα、GRβ蛋白表达及GRα/GRβ均无统计学差异（均P＞0.05）。结论OSAHS患儿的腺样体组织对糖皮质激素（GC）的敏感性优于扁桃体组织,不同缺氧严重程度患儿间比较,激素受体表达无统计学差异,GC在OSAHS患儿的作用有待深入研究。     

光电容积脉搏波的睡眠呼吸暂停综合征筛查方法

睡眠呼吸暂停综合征（SAS）素有“睡眠杀手”之称。由于其诊断金标准多导睡眠监测仪（PSG）的限制,诊断率一直偏低。由于呼吸暂停发生时会引发心率节奏的变化,因此利用心电图（ECG）通过心率变异性（HRV）分析可以实现SAS的自动筛查。但是,ECG-SAS方法所用电极穿戴繁琐、材质致敏性较高,影响睡眠安适度。鉴于脉率变异性（PRV）分析与HRV分析高度相关,并且光电容积脉搏波（PPG）信号相对ECG信号获取方式更加简单,不仅电极不易致敏,而且更易于穿戴,对睡眠干扰小。由此,提出利用同步采集的PPG信号和ECG信号,应用相同的建模方法,比较二者的疾病识别能力。应用反向传播（BP）神经网络,分别建立PPG-SAS与ECG-SAS自动筛查模型,并采用十折交叉验证法及受试者工作特征（ROC）曲线对模型进行对比与评估。实验数据来源于MIT-BIH Polysomnographic Database,共8 248个样本,其中正常样本6 227例。首先采用三层BP神经网络,默认参数下建立PPG-SAS与ECG-SAS模型,使用十折交叉验证法及ROC曲线进行模型分类准确性的对比;然后依次改变影响分类性能的隐层节点数、训练函数以及传递函数,建立多个PPG-SAS与ECG-SAS模型,从中选取各自的最优模型再进行对比。通过比较识别率、预测率以及ROC曲线面积,采用默认参数的PPG-SAS模型优于ECG-SAS模型。通过比较平均分类准确率,隐层节点数为50、训练函数为一步正割算法、隐含层传递函数为双曲正切S型函数时,PPG-SAS模型得到的最高识别率与预测率分别为80.30%和80.13%;隐层节点数为50、训练函数为一步正割算法、隐含层传递函数为径向基时,ECG-SAS模型的最高识别率与预测率分别为77.60%和77.67%。以上实验结果均表明PPG信号的SAS分类能力较ECG信号更具优越性,由此证明了PPG信号筛查SAS的可行性及可靠性,为临床SAS病症的早期发现及诊断率提升奠定理论基础。     

基于神经网络的WiFi睡眠呼吸暂停智能监测技术

为了克服传统睡眠呼吸监测方案未考虑实际受测人员在测试区域可能存在呼吸暂停、正常呼吸或者离开测试区域的问题,设计一种基于家庭WiFi的睡眠呼吸暂停智能监测系统。利用线性拟合消除接收天线的信道状态信息 (channel state information, CSI) 相位误差,并利用小波变换去除信号幅值的噪声;结合短时傅里叶变换和滑动窗口法对信号进行分割;提取天线间相位差的方差等特征并利用神经网络模型对呼吸暂停进行识别,排除睡姿变化带来的干扰。实验结果表明,该系统对于呼吸暂停的检测率达到95.6%以上,能够作为日常的呼吸暂停监测方案并为用户提供健康参考。     

基于短时能量的呼吸暂停信号识别方法

呼吸暂停是一种常见的疾病,严重的呼吸暂停会导致患者猝死。针对患者需要对睡眠过程中呼吸信号进行实时监测,提出了一种基于短时能量的呼吸暂停信号识别监测方法。该方法基于患者呼吸过程的信号频域特性,先对不同的患者进行自适应鼾声特征信号建模;之后通过神经网络信号识别方法,利用建立的模型对患者的呼吸信号进行呼吸暂停判断。实验结果表明,对不同的患者进行睡眠呼吸过程进行监测时,可以识别95%的呼吸暂停信号,本方法为呼吸暂停患者的实时监测提供了一种高精度的信号识别方法。     

阻塞性睡眠呼吸暂停综合征和重叠综合征患者的血浆内皮素变化的临床观察

目的：探讨阻塞性睡眠呼吸暂停综合征（OSAS）以及OSAS合并慢性阻塞性肺疾病（以下称重叠综合征）患者的血浆内皮素（ET-1）的变化及其与睡眠呼吸紊乱的关系.方法：平行开放的方法选取患者80例,其中单纯OSAS患者40例（A组）,重叠综合征患者40例（B组）,以及同期健康体检者为对照组30例（C组）,观察记录3组ET-...     

Numerical analysis for the efficacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea-hypopnea syndrome（OSAHS） patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The effcacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram（PSG） test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further,provide a theoretical basis to solve relevant clinical problems.     

等离子铺助下H-UPPP手术治疗重度阻塞性睡眠呼吸暂停低通气综合征

目的:探讨低温等离子铺助下行H-UPPP手术,肥厚软腭、悬雍垂及腭咽肌射频消融治疗重度OSAHS的疗效.方法:回顾分析经PGS监测、阻塞平面在口咽部的60例重度OSAHS患者,用EIC5874刀头的融切功能行H-UPPP手术,对肥厚软腭、悬雍垂及腭咽肌用EIC4855刀头射频消融.结果:患者术后口咽腔左右、前后径扩大,咽腔结构、功能完整.术后6~12月随访并行PGS监测,AHI值下降、LSaO2升高差异有统计学意义(P<0.01).患者主观症状改善,有效率达到91.7%.结论:OSAHS的外科治疗方法多种多样,对于阻塞平面在口咽部的重度OSAHS患者,等离子铺助下H-UPPP手术,具有出血少、创伤小,又能保留咽腔结构及功能的有效治疗.     

术中不同浓度氧对病态肥胖阻塞性睡眠呼吸暂停综合征患者术后早期动脉血氧分压的影响

目的观察术中吸入不同浓度氧对病态肥胖患者术后早期动脉血氧分压的影响。方法选择40例ASAⅢ级、因阻塞性睡眠呼吸暂停综合征（OSAS）拟择期行悬雍垂腭咽成形术的病态肥胖（BMI≥40kg／m^2）患者,采用随机数字表法分成80％氧浓度吸入组（H组）和60％氧浓度吸入组（L组）,各20例,测定术前（T0）、气管拔管后10min（T1）、0．5h（T2）、2h（T3）的动脉血气分析指标并作比较。结果两组患者1Io时动脉血气分析中的SaO2、PaO2、PaCO2、pH值的差异均无统计学意义（均P〉0．05）,在T1、T2、T3各时点L组的SaO2、PaO2值明显高于H组（P〈0．05或0．01）,在T、时点,L组的PaCO2明显低于H组（P〈0．05）。结论相较于80％的吸入氧浓度,病态肥胖的OSAS患者术中吸入60％浓度的氧,术后的氧合更好,有利于术后早期呼吸功能的恢复。