透明隔腔增宽引起中枢性睡眠呼吸暂停综合征1例
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摘要
中枢性睡眠呼吸暂停(CSA)的特点是睡眠时因中枢驱动功能受损而引起的反复气流中断。笔者在临床中见一例35岁无基础疾病的睡眠打鼾的中青年患者,经PSG监测诊断为中枢性睡眠呼吸暂停综合征:透明隔间腔及V氏间腔增宽。笔者考虑其CSA可能与透明隔间腔增宽致控制睡眠的相关中枢驱动功能受损有关。经伺服通气呼吸机治疗后,患者微觉醒指数、AHI、氧减饱和指数、呼吸暂停-低通气时间均明显降低,睡眠结构恢复正常,睡眠质量明显改善。现报道如下。
The characteristic of CSA( central sleep apnea) is the frequent air current interruptions caused by the damage to the function of central drive during sleep. Clinically,a 35-year-old patient,snoring without basic diseases,was diagnosed as having CSA by PSG monitoring and the broadening in both cavity of septum pellucidum and V-cavity by head MRI. The writer thought that the CSA syndrome was probably related to the damage to the sleep-related central drive function caused by the broadening in the cavity of septum pellucidum. After the treatment by ASV( auto servo ventilator),the patient's micro-arousal index,AHI,oxyhemoglobin desaturation index and apnea-hypopnea time have reduced significantly,his sleep structure has switched back,and the sleep quality has improved significantly. The details of the case will be reported as follows.
The characteristic of CSA( central sleep apnea) is the frequent air current interruptions caused by the damage to the function of central drive during sleep. Clinically,a 35-year-old patient,snoring without basic diseases,was diagnosed as having CSA by PSG monitoring and the broadening in both cavity of septum pellucidum and V-cavity by head MRI. The writer thought that the CSA syndrome was probably related to the damage to the sleep-related central drive function caused by the broadening in the cavity of septum pellucidum. After the treatment by ASV( auto servo ventilator),the patient's micro-arousal index,AHI,oxyhemoglobin desaturation index and apnea-hypopnea time have reduced significantly,his sleep structure has switched back,and the sleep quality has improved significantly. The details of the case will be reported as follows.
引文
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[3]Trimble MR.The limbic system and related anatomical connections[M].New York:Raven Press,1991.40-61.
[4]Sarwar M.The septum pellucidum:normal and abnormal[J].A-JNR,1989,10(5):989-1005.
[5]Kaada B R,Pribram K H,Epstein J A.Respiratory and vascular responses in monkeys from temporal pole,insula,orbital surface and cingulate gyrus:a preliminary report[J].Journal of Neurophysiology,1949,12(5):347-356.
[6]Showers M J.The cingulate gyrus:additional motor area and cortical autonomic regulator[J].Journal of Comparative Neurology,1959,112(1):231-301.
[7]Speakman T J,Babkin B P.Effect of cortical stimulation on respiratory rate[J].American Journal of Physiology,1949,159(2):239.
[8]Ward A A.The cingular gyrus:area 24[J].Journal of Neurophysiology,1948,11(1):13.
[9]Lewin W,Whitty C W.Effects of anterior cingulate stimulation in conscious human subjects[J].Journal of Neurophysiology,1960,23(4):445-447.
[10]Scoville W B.The limbic lobe in man[J].Journal of Neurosurgery,1954,11(1):64-66.
[11]Kaada B R,Jasper H.Respiratory responses to stimulation of temporal pole,insula,and hippocampal and limbic gyri in man[J].A.m.a.archives of Neurology&Psychiatry,1952,68(5):609.
[12]芮德源,朱雨岚,陈立杰.临床神经解剖学[M].北京:人民卫生出版社,2015:524.
[13]芮德源,朱雨岚,陈立杰.临床神经解剖学[M].北京:人民卫生出版社,2015:358.
[14]朱长庚.神经解剖学[M].北京:人民卫生出版社,2002:725.
[15]Bodensteiner JB,Schaefer GB.Wide cavum septum pellucidum:a marker of disturbed brain development[J].Pediatr Neurol,1990,6(6):391-394.
[16]Parreira VF,Jounieux V,Aubert G,et al.Nasal two-level positive-predssure ventilation in normal subjects.Effects of the glottis and ventilation.Am J Repir Crit Care Med 1996,153:1616-1623.
[2]刘炜,蔡爱露.透明隔腔的超声诊断及其临床意义[J].中国临床医学影像杂志,2008,(05):353-355.
[3]Trimble MR.The limbic system and related anatomical connections[M].New York:Raven Press,1991.40-61.
[4]Sarwar M.The septum pellucidum:normal and abnormal[J].A-JNR,1989,10(5):989-1005.
[5]Kaada B R,Pribram K H,Epstein J A.Respiratory and vascular responses in monkeys from temporal pole,insula,orbital surface and cingulate gyrus:a preliminary report[J].Journal of Neurophysiology,1949,12(5):347-356.
[6]Showers M J.The cingulate gyrus:additional motor area and cortical autonomic regulator[J].Journal of Comparative Neurology,1959,112(1):231-301.
[7]Speakman T J,Babkin B P.Effect of cortical stimulation on respiratory rate[J].American Journal of Physiology,1949,159(2):239.
[8]Ward A A.The cingular gyrus:area 24[J].Journal of Neurophysiology,1948,11(1):13.
[9]Lewin W,Whitty C W.Effects of anterior cingulate stimulation in conscious human subjects[J].Journal of Neurophysiology,1960,23(4):445-447.
[10]Scoville W B.The limbic lobe in man[J].Journal of Neurosurgery,1954,11(1):64-66.
[11]Kaada B R,Jasper H.Respiratory responses to stimulation of temporal pole,insula,and hippocampal and limbic gyri in man[J].A.m.a.archives of Neurology&Psychiatry,1952,68(5):609.
[12]芮德源,朱雨岚,陈立杰.临床神经解剖学[M].北京:人民卫生出版社,2015:524.
[13]芮德源,朱雨岚,陈立杰.临床神经解剖学[M].北京:人民卫生出版社,2015:358.
[14]朱长庚.神经解剖学[M].北京:人民卫生出版社,2002:725.
[15]Bodensteiner JB,Schaefer GB.Wide cavum septum pellucidum:a marker of disturbed brain development[J].Pediatr Neurol,1990,6(6):391-394.
[16]Parreira VF,Jounieux V,Aubert G,et al.Nasal two-level positive-predssure ventilation in normal subjects.Effects of the glottis and ventilation.Am J Repir Crit Care Med 1996,153:1616-1623.