目的 观察电刺激结合咽部肌群训练对脑卒中并发阻塞性睡眠呼吸暂停综合征(OSAS)患者临床症状、睡眠呼吸参数及认知功能的影响。方法 2014年12月1日至2017年11月30日,脑卒中并发OSAS住院患者50例,随机分为对照组和研究组各25例。两组均接受常规药物治疗及康复训练,研究组在此基础上接受VocaStim®-Master电刺激,包括咽部神经肌肉电刺激和舌下神经分支刺激,以及咽部肌群训练,共4周。记录干预前后临床症状变化,采用多导睡眠呼吸监测(PSG)及简明精神状况检查(MMSE)进行评定。结果 治疗后,研究组临床症状较治疗前及对照组改善(P < 0.05),睡眠呼吸紊乱指数(AHI)下降(t > 2.270, P < 0.05),平均血氧饱和度、最低血氧饱和度明显增高(t > 3.095, P < 0.01),氧减指数显著下降(t > 3.044, P < 0.01),MMSE评分明显增高(t > 2.859, P < 0.01)。对照组治疗前后AHI、平均血氧饱和度、最低血氧饱和度、氧减指数和MMSE评分均较治疗前无显著性差异(P > 0.05)。结论 VocaStim®-Master电刺激结合咽部肌群训练能有效缓解脑卒中并发OSAS患者的临床症状,改善呼吸功能和认知功能。
Objective To investivate the effects of VocaStim?-Master electrical stimulation and pharyngeal muscles training on sleep breathing parameters, clinical symptoms and cognitive functions in stroke patients with obstructive sleep apnea syndrome (OSAS). Methods From December 1st, 2014 to November 30th, 2017, 50 stroke patients complicated with OSAS were divided into control group (n = 25) and research group (n = 25). All the patients received routine medicine and rehabilitation, while the research group accepted VocaStim?-Master electrical stimulation and pharyngeal muscles training in addition, for four weeks. Their symptoms were observed, and tested with polysomnography (PSG) and Mini-Mental State Examination (MMSE) before and after treatment.Results After treatment, the clinical symptoms improved (P < 0.05), while apnea hypopnea index (AHI) (t > 2.270, P < 0.05)and oxygen desaturation index (t > 3.044, P < 0.01) decreased, and average oxygen saturation (SaO2) and lowest SaO2 increased (t > 3.095, P < 0.01), in the research group, compared with those before treatment and those in the control group (P < 0.05), the scores of MMSE increased (t > 2.859, P < 0.01). There was no significant difference of AHI, averge SaO2, lowest SaO2 and oxygen desaturation index during the period of treatment in the control group (P > 0.05), nor for the score of MMSE.Conclusion VocaStim?-Master electrical stimulation combined with pharyngeal muscles training could effectively ameliorate nocturnal sleep apnea symptom and improve cognitive functions in stroke patients complicated with OSAS.
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