中老年原发性慢性失眠患者脑血管储备能力研究.docVIP

中老年原发性慢性失眠患者脑血管储备能力研究 　　[摘要] 目的 采用屏气试验研究中老年原发性慢性失眠患者颅内大动脉血流储备能力。 方法 选取年龄在45～60岁无神经系统局灶体征的原发性慢性失眠患者65例为研究对象（慢性失眠组），健康体检者65例（健康对照组）。通过经颅多普勒超声应用屏气试验（breath-holding test）检测每位受试者脑血管储备（cerebrovascular reserve，CVR），对两组结果进行比较分析。 结果 屏气试验诱发颅内血管血流速度增加。慢性失眠组患者血管储备能力较健康对照组下降，差异有统计学意义（P 　　[关键词] 慢性失眠；脑血管储备；经颅多普勒；屏气试验 　　[中图分类号] R592 [文献标识码] B [文章编号] 1673-9701（2017）04-0044-03 　　Study on the cerebrovascular reserve capacity in middle-aged and elderly patients with primary chronic insomnia 　　YANG Xu 　　Department of No.2 Neurology，Dalian Friendship Hospital in Liaoning Province，Dalian 116001，China 　　[Abstract] Objective To study the reserve ability of intracranial large arterial blood flow in the middle-aged and elderly patients with chronic primary insomnia by breath holding test. Methods A total of 65 patients with primary chronic insomnia who were between 45～60 years old and were without local focus in neurological system were selected as study subjects（chronic insomnia group），and 65 cases of healthy subjects （healthy control group）. The cerebrovascular reserve was tested by breath holding test via transcranial doppler ultrasonography. The results were compared and analyzed between the two groups. Results The breath holding test induced the increased intracranial blood flow velocity. The blood vessel reserve capacity in the chronic insomnia group was lower than that in the healthy control group， and the difference was statistically significant（P 　　原发性慢性失眠纳入标准：依据国际睡眠障碍分类-第三版（ICSD-3）对慢性失眠的定义[2]，至少3个月每周内至少3 d 拥有下列问题之一：入睡困难，维持睡眠困难，比预期醒的早，无法按时入睡，没有父母或照顾者难以入睡。排除标准：继发性失眠[3]，如由肿瘤、药物滥用、心肺疾病、疼痛，不安腿综合征和其他身心疾患引起的失眠；存在神经系统阳性体征者；有心肺系统疾病者；脑血管病病史者；高血压病病史者；糖尿病病史者。 　　1.2 方法 　　TCD检查：采用 DWL公司Multi-Dop×2 TCD检测仪，2 MHz探头经颞窗检查双侧大脑中动脉，记录收缩期峰速度（Vs）、舒张期末峰速度（Vd）、平均血流速度（Vm）。 　　CVR检查：屏气试验[4]：受检者正常吸气后屏住呼吸30 s，记录屏气前后双侧大脑中动脉平均血流速度（Vm）。屏气后 Vm增加率 =[（屏气后-平静呼吸时 Vm）/平静呼吸时Vm]×100%。屏气指数[5]（BHI）=[（屏气后Vmmax-平静呼吸时Vm）/平静呼吸时Vm]×100/30。 　　1.3观察指标 　　分别记录平静呼吸时及屏气后大脑中动脉平均血流速度，计算两组Vm增加率及屏气指数。 　　1.4 统计分析 　　采用 SPSS 17.