【中图分类号】R246.81 【文献标识码】A 【文章编号】1007-8231（2018）33-0080-02
阻塞性呼吸暂停低通气综合征（OSAHS）是患者睡眠中反复发生上呼吸道完全或不完全阻塞而导致频繁的呼吸暂停或通气量减低的睡眠呼吸疾病。患者以夜间睡眠反复出现上气道阻塞为特征，主要表现为打鼾、憋气、晨起头痛头晕，日间嗜睡乏力等症状。OSAHS是心脑血管疾病、高血压病、糖尿病、老年痴呆的多种严重危害人类健康疾病的重要危险因素。针刺疗法可治疗肌肉病变和中枢神经系统病变引起的周围肌肉功能减退，并可通过对周围组织的持续刺激效应而反射性地调节中枢神经系统功能，进而改善中枢神经病变及OSAHS治疗效果，具有操作简便、患者易接受等特点。近年来，越来越多的研究者采用针刺疗法治疗OSAHS并取得了良好的疗效[1]。本文报告通过针刺治愈此病一例。
患者杨某某，男，48岁，因睡眠打鼾15年，夜间憋气，白天嗜睡3年余就诊。查体：肥胖体型，咽腔狭小，悬雍垂粗长，软腭肥大。心肺未发现异常，既往无慢性心肺疾病史。睡眠呼吸电脑监测结果为8小时睡眠呼吸暂停48次，最长呼吸暂停时间29秒，平均呼吸暂停时间12秒，暂停指数6次每小时，诊断为阻塞性睡眠呼吸暂停低通气综合征。经中医辨证为脾肾阳虚，痰湿内阻，给予针刺治疗，选用内关，百会，丰隆，太溪，廉泉等穴，每次选用4个穴位，每日一次，针刺时大幅度提插捻转，留针30分钟，疗程为20天，同时嘱其注意饮食，加强锻炼。20天后打鼾，夜间憋气症状基本消失，白天嗜睡症状有所好转。查体：心肺正常。睡眠呼吸电脑监测结果为8小时睡眠呼吸暂停20次，最长呼吸暂停22秒，平均呼吸暂停时间10秒，暂停指数3.2次每小时，未达到阻塞性睡眠呼吸暂停低通气综合征诊断标准。停止针刺治疗后一个月，病情平稳。
OSAHS是临床常见的一种睡眠呼吸障碍性疾病，临床表现为嗜睡、嗜卧、多寐等，属中医学“嗜卧”“鼾眠”“嗜睡”等范畴[2]。OSAHS诱发因素较复杂，除实质占位性病变、解剖结构异常等外，还包括咽喉部病理性改变和呼吸中枢神经病变等[3-4]。现代医学研究显示，OSAHS主要是由于咽部软组织肥大、咽部肌张力下降、气道缩短等导致气道上段可逆性阻塞或不畅引起呼吸暂停或低通气，部分患者发病可能与神经中枢对低氧的敏感性下降有关[5]。长期反复发作的低氧及高碳酸血症可导致全身组织器官缺血、缺氧，进而引起全身多系统器官功能损伤。近年来中医特色针刺疗法治疗OSAHS取得了良好效果，针刺疗法通过直接作用于穴位可有效改善呼吸反射中枢神经系统功能，不仅扶助正气，还祛除滞于体内的邪气，促进新陈代谢。其中廉泉穴、旁廉泉穴在针刺疗法中出现频率最高，可能原因为廉泉穴、旁廉泉穴下存在大量神经，针刺该穴位可有效改善咽部扩张肌功能及舌后气道功能，疗效显著[6-7]。
中医认为本病为阳气虚衰，痰湿内生，痰气交阻，气机不畅发为打鼾，治宜健脾补肾，化痰通浊，故选用上述穴位进行针刺治疗，效果良好。针刺取得效果时应延长治疗时间，巩固疗效。个人体会针刺达到效果的机制可能在于针刺提高了呼吸道平滑肌收缩肌力以及通过调节控制呼吸的神经系统，从而改善呼吸暂停。
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Obstructive apnea hypopnea syndrome (OSAHS) is a kind of sleep respiratory disease in patients with recurrent complete or incomplete upper respiratory tract obstruction resulting in frequent apnea or decreased ventilation. Acupuncture therapy can be used to treat the peripheral muscle dysfunction caused by muscle and central nervous system diseases, and can be treated by the treatment of peripheral muscle dysfunction. The continuous stimulation of peri-tissue reflexively regulates the function of central nervous system and improves the therapeutic effect of central nervous lesion and OSAHS. It is easy to operate and easy to accept by patients. In recent years, more and more researchers have used acupuncture therapy to treat OSAHS and achieved good results.This paper reports a case of treating this disease by acupuncture.
Patient Yang Xime, 48 years old, snoring for 15 years, hold his breath at night, daytime drowsiness for more than 3 years. Body check: fat body, narrow pharynx, uvula, soft palate hypertrophy. No abnormality was found in the heart and lung, and there was no history of chronic cardiopulmonary disease. The results of computer monitoring of sleep apnea were 8 hours sleep apnea 48 times, the longest apnea time 29 seconds, the average apnea time 12 seconds, the apnea index 6 times per hour, diagnosed as obstructive sleep apnea hypopnea syndrome. TCM syndrome differentiation for spleen and kidney yang deficiency, phlegm dampness internal obstruction, acupuncture treatment, choose Neiguan, Baihui, Fenglong, Taixi, Lianquan and other points, each time, Four acupoints were selected once a day, and the acupuncture points were lifted and twirled by a large margin, and the needle was kept for 30 minutes for 20 days. At the same time, they were advised to pay attention to diet, to strengthen their snoring after 20 days of exercise, to basically disappear the symptoms of choking at night, and to improve the symptoms of sleepiness during the day. Physical examination: normal heart and lung. The results of computer monitoring of sleep apnea were 8 hours sleep apnea 20 times, the longest apnea 22 seconds, the average apnea time 10 seconds, the apnea index 3.2 times per hour, which did not meet the diagnostic criteria of obstructive sleep apnea hypopnea syndrome. One month after stopping acupuncture treatment, the condition was stable.
【参考文献】
[1]徐佳,牛燕霞,朴雪梅,等.针刺对阻塞性睡眠呼吸暂停低通气综合征患者[J].中国针灸,2009,29(1):84-86
[2]王赟芝.针刺治疗急性脑梗死合并阻塞性睡眠呼吸暂停低通气综合征疗效观察[J].上海针灸杂志,2015,34(11):1027-1030.
[3]张丽秀,仕丽,周海燕,等.针刺治疗阻塞性睡眠呼吸暂停低通气综合征90例临床疗效观察[J].中国卫生产业,2014,20 (24):192-193.
[4]丁丽凤,李幼瑾.针灸结合西药治疗轻中度儿童阻塞性睡眠呼吸暂停综合征临床观察[J].上海中医药杂志,2017,51 (1):70-72.DOI:10.16305/j.issn.1007-1334.2017.01.021.
[5]付柳英,苏晶,赵丽英.阻塞性睡眠呼吸暂停低通气综合征患者体脂分布特点研究[J].中国老年学杂志,2007,27(1):51-53.
[6]王婧,陈锐,彭万达,等.肥胖对中重度阻塞性睡眠呼吸暂停低通气综合征患者认知功能障碍的影响[J].中华医学杂志, 2013, 93 (48):3817-3821.DOI:10.3760/cma.j.issn.0376-2491.2013.48.003.
[7]谭曦舒,李立群,胡玲玲,等.COPD患者血清MCP-1、SAA水平与认知功能的相关性研究[J].四川大学学报(医学版) , 2016,47(6):957-959.
论文作者:王晓霜
论文发表刊物:《心理医生》2018年33期
论文发表时间:2018/12/7
标签：针刺论文; 呼吸论文; 睡眠论文; 综合征论文; 患者论文; 阻塞性论文; 功能论文; 《心理医生》2018年33期 论文;