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--> 00:00.597\n嗯，\n\n00:00.597 --> 00:01.172\n大家好，\n\n00:01.172 --> 00:03.947\n我是周浦医院呼吸科魏丽医生。\n\n00:03.947 --> 00:07.046\n今天和大家一起聊一聊睡眠打鼾。\n\n00:12.967 --> 00:15.767\n老百姓通常都认为打呼噜是睡得香，\n\n00:15.767 --> 00:17.617\n其实这个观点是错误的。\n\n00:17.966 --> 00:18.316\n嗯，\n\n00:18.316 --> 00:21.566\n现在随着大家生活水平的越来越高，\n\n00:21.716 --> 00:22.117\n嗯，\n\n00:22.617 --> 00:25.666\n身边有很多比较肥胖的患者，\n\n00:25.666 --> 00:28.367\n他们通常会有打呼的这个症状，\n\n00:28.517 --> 00:30.466\n打呼睡眠有暂停。\n\n00:32.081 --> 00:33.831\n我们首先来说一下睡眠的作用，\n\n00:34.280 --> 00:35.530\n人为什么要睡眠呢？\n\n00:35.530 --> 00:37.730\n睡眠它可以促进脑功能的发育，\n\n00:37.881 --> 00:39.155\n它可以巩固记忆，\n\n00:39.155 --> 00:41.081\n促进体力精力的恢复。\n\n00:41.530 --> 00:41.855\n嗯，\n\n00:41.855 --> 00:43.456\n白天工作一天很疲劳，\n\n00:43.456 --> 00:46.206\n身体需要一个恢复的过程，\n\n00:46.206 --> 00:47.280\n需要睡眠。\n\n00:47.430 --> 00:49.131\n它可以促进它的生长，\n\n00:49.131 --> 00:50.055\n延缓衰老，\n\n00:50.055 --> 00:51.581\n增强它的免疫功能。\n\n00:52.613 --> 00:52.813\n嗯，\n\n00:52.863 --> 00:54.863\n你睡眠有打呼吗？\n\n00:54.863 --> 00:57.964\n打呼的病人在生活中其实是蛮多的。\n\n00:58.888 --> 00:59.839\n其实这是一种病，\n\n00:59.888 --> 01:01.638\n不是说睡眠质量好。\n\n01:03.108 --> 01:03.408\n他是。\n\n01:05.029 --> 01:07.330\n睡眠中的隐形杀手啊，\n\n01:08.080 --> 01:10.004\n睡眠呼吸暂停综合征，\n\n01:10.004 --> 01:11.529\n今天我们来说一说这个。\n\n01:12.277 --> 01:12.527\n嗯，\n\n01:12.678 --> 01:14.453\n疾病在欧美国家，\n\n01:14.453 --> 01:17.627\n大概有2%.4%的人会有睡眠打鼾。\n\n01:18.730 --> 01:22.379\n我国大概是3.5%.4.8%有睡眠打鼾。\n\n01:22.730 --> 01:23.080\n嗯，\n\n01:23.080 --> 01:25.654\n生育期内男性明显是多于女性的，\n\n01:25.654 --> 01:29.730\n更年期女性患者的患病率是明显升高的，\n\n01:29.930 --> 01:31.629\n老年人发生率比较多，\n\n01:31.629 --> 01:34.480\n65岁以上重症减少。\n\n01:35.919 --> 01:36.019\n嗯，\n\n01:36.019 --> 01:37.470\n就肥胖的患者比较多，\n\n01:37.620 --> 01:39.595\n或者是有小颌畸形啊，\n\n01:39.595 --> 01:43.669\n或者是有鼻鼻窦炎、扁桃体肥大这些。\n\n01:44.761 --> 01:45.060\n嗯。\n\n01:46.949 --> 01:47.250\n嗯，\n\n01:47.250 --> 01:48.300\n这是一个漫画，\n\n01:48.550 --> 01:48.875\n嗯，\n\n01:48.875 --> 01:49.900\n大家看到这个。\n\n01:50.929 --> 01:52.054\n这个这这这个人，\n\n01:52.054 --> 01:53.778\n他的是脑袋大脖子粗。\n\n01:56.264 --> 01:56.940\n这是一个漫画，\n\n01:56.940 --> 01:59.665\n是1836年英国小说家狄更斯的。\n\n02:00.578 --> 02:04.027\n皮克威克外传塑造了一个叫乔的胖男孩，\n\n02:04.027 --> 02:07.027\n一天中大部分的时间都在吃与睡中度过。\n\n02:07.377 --> 02:08.677\n面色是紫红，\n\n02:08.677 --> 02:09.652\n全身是浮肿，\n\n02:09.652 --> 02:10.777\n性格是怪癖的，\n\n02:10.777 --> 02:12.227\n白天睡嗜睡，\n\n02:12.427 --> 02:15.578\n平时很难将他从病态的睡眠中唤醒。\n\n02:15.878 --> 02:19.195\n睡眠的鼾声是很大的一个，\n\n02:19.195 --> 02:20.378\n是被认为，\n\n02:20.628 --> 02:25.177\n是最早描述睡眠呼吸暂停综合症的特征的第一人。\n\n02:28.863 --> 02:34.912\nSARS多种原因导致睡眠状态下反复出现呼吸暂停、呼吸中断，\n\n02:35.013 --> 02:37.138\n引起间歇性的低氧血症，\n\n02:37.138 --> 02:40.013\n伴有高碳酸血症以及睡眠结构的紊乱，\n\n02:40.162 --> 02:45.863\n进而使机体发生一系列病理生理改变的临床特征。\n\n02:47.970 --> 02:49.320\n我首先说一下它的概念，\n\n02:49.369 --> 02:50.619\n睡眠呼吸暂停，\n\n02:51.070 --> 02:53.270\n但是在睡眠的过程中，\n\n02:53.419 --> 02:56.770\n口鼻呼吸气流完全停止10秒以上。\n\n02:57.320 --> 03:04.520\n低通气是睡眠过程中口鼻气流较基础水平降低大于等于百分之之30，\n\n03:04.520 --> 03:08.220\n伴有动脉血氧饱和度下降大于等于4%，\n\n03:08.570 --> 03:13.320\n或者口鼻气流较基线水平下降50%，\n\n03:13.320 --> 03:18.070\n伴有氧饱和度的下降大于等于3%或者未觉。\n\n03:18.216 --> 03:23.466\n型睡眠呼吸暂停低通气指数是指每小时睡眠的时间内，\n\n03:23.466 --> 03:25.966\n呼吸暂停加低通气的次数。\n\n03:29.322 --> 03:33.746\n分类有阻塞性的睡眠呼吸暂停、中枢性的睡眠呼吸暂停，\n\n03:33.746 --> 03:35.722\n还有混合性的睡眠呼吸暂停。\n\n03:36.421 --> 03:36.822\n嗯，\n\n03:37.121 --> 03:41.447\n阻塞性的睡眠呼吸暂停就是口鼻气流是停掉的，\n\n03:41.447 --> 03:43.472\n但是它的胸腹运动是存在的。\n\n03:43.621 --> 03:45.296\n中枢性的睡眠呼吸暂停，\n\n03:45.296 --> 03:46.972\n大家看这三条线是直的，\n\n03:46.972 --> 03:48.197\n它是口鼻气流，\n\n03:48.197 --> 03:49.046\n还有胸带啊，\n\n03:49.046 --> 03:49.647\n腹带呀，\n\n03:49.647 --> 03:50.921\n这些都是一条直线，\n\n03:50.921 --> 03:52.871\n是没有没有运，\n\n03:52.871 --> 03:53.822\n没有动作的，\n\n03:53.822 --> 03:58.371\n混合性的话就是第三幅图这种它都有一点啊，\n\n03:58.371 --> 03:59.472\n睡眠姿势睡眠。\n\n03:59.555 --> 04:00.005\n通气。\n\n04:00.962 --> 04:01.662\n最后一个，\n\n04:02.063 --> 04:03.662\n它的病因和发病机制，\n\n04:04.013 --> 04:08.563\n中枢性的呼吸睡眠暂停综合征。\n\n04:08.962 --> 04:09.313\n嗯，\n\n04:09.313 --> 04:12.162\n还有一个是阻塞性的睡眠呼吸暂停综合症。\n\n04:12.212 --> 04:13.037\n在临床上，\n\n04:13.037 --> 04:18.662\n我们是o ss见的是比较多的是阻塞性的呼吸睡眠暂停综合征。\n\n04:18.662 --> 04:19.013\nC,\n\n04:19.013 --> 04:20.912\n中枢性的也也也有，\n\n04:20.912 --> 04:21.863\n但是比较少。\n\n04:23.830 --> 04:28.381\n阻塞性的睡眠呼吸暂停常见于鼻窦炎、鼻息肉、鼻中隔弯曲，\n\n04:28.781 --> 04:30.305\n还有一个扁桃体比较大。\n\n04:30.305 --> 04:31.580\n你看这下面的图片，\n\n04:31.980 --> 04:33.555\n还有一个腺样体肥大。\n\n04:33.555 --> 04:34.531\n小朋友的话，\n\n04:34.531 --> 04:39.230\n腺样体肥大会引起他老是晚上会发生，\n\n04:39.230 --> 04:41.281\n会引起他。\n\n04:43.001 --> 04:44.450\n睡睡得不是很踏实，\n\n04:44.550 --> 04:45.901\n氧饱和度会下降。\n\n04:50.035 --> 04:51.285\n正常气情况下，\n\n04:51.334 --> 04:53.309\n我们气道是保持通畅的。\n\n04:53.309 --> 04:54.385\n大家看这幅图，\n\n04:54.635 --> 04:56.934\n气体是自由进出肺部，\n\n04:57.434 --> 04:58.910\n然后进行气体交换，\n\n04:58.910 --> 05:02.984\n保证机体供氧以及排出代谢产生的二氧化碳。\n\n05:03.916 --> 05:05.566\n这是一个正常的图片。\n\n05:06.447 --> 05:06.548\n嗯，\n\n05:06.548 --> 05:07.747\n打鼾的呼吸呢，\n\n05:07.747 --> 05:10.923\n是气道是比正常人是要狭窄的啊。\n\n05:10.923 --> 05:12.247\n呼吸期间呢，\n\n05:12.247 --> 05:14.548\n上气道是塌陷和气流受阻。\n\n05:14.997 --> 05:18.773\n气流通过狭窄的部位时会产生涡流并引起震荡，\n\n05:18.773 --> 05:19.798\n产生鼾声，\n\n05:20.197 --> 05:22.097\n这就是鼾声产生的机制。\n\n05:22.597 --> 05:23.523\n严重的时候，\n\n05:23.523 --> 05:25.023\n气流会完全的阻塞，\n\n05:25.023 --> 05:27.048\n产生呼吸暂停就是。\n\n05:28.110 --> 05:28.311\n嗯，\n\n05:28.510 --> 05:31.835\n中间就是呼吸过程中突然没有呼吸了，\n\n05:31.835 --> 05:36.960\n然后等个一段时间才会有一次比较深大的呼吸，\n\n05:36.960 --> 05:38.210\n这就呼吸暂停。\n\n05:40.618 --> 05:41.067\n这种呢，\n\n05:41.067 --> 05:43.442\n是夜间临床是比较多见的啊。\n\n05:43.442 --> 05:45.868\n夜间临床的表现和白天临床的表现。\n\n05:47.932 --> 05:49.582\n全身器官的损害，\n\n05:49.682 --> 05:52.631\n它会引起睡眠呼吸暂停。\n\n05:52.631 --> 05:54.881\n它会引起呼吸道的症状。\n\n05:54.881 --> 05:58.807\n它会引起心心脑心心血管方面的疾病，\n\n05:58.807 --> 06:00.932\n比如高血压、心心脏病，\n\n06:01.182 --> 06:03.457\n还会引起内分泌的问题，\n\n06:03.457 --> 06:05.182\n比如糖尿病啊，\n\n06:05.182 --> 06:06.932\n还会引起神经科的问题，\n\n06:06.981 --> 06:08.582\n记忆力减退这些。\n\n06:09.657 --> 06:09.856\n嗯。\n\n06:12.589 --> 06:15.040\n临床表现与特征体征的话，\n\n06:15.040 --> 06:17.890\n就是患者比较肥胖，\n\n06:17.890 --> 06:19.165\n鼻甲是肥大的，\n\n06:19.165 --> 06:20.690\n鼻中隔是偏曲的，\n\n06:20.940 --> 06:22.915\n有些小颌畸形，\n\n06:22.915 --> 06:23.940\n舌体肥大，\n\n06:24.190 --> 06:25.714\n口咽部阻塞等。\n\n06:25.714 --> 06:26.290\n就是说，\n\n06:26.290 --> 06:29.790\n近期进出气道的这个气道是有阻塞。\n\n06:31.292 --> 06:31.542\n查体，\n\n06:31.542 --> 06:33.842\n我们主要是查一些动脉血气呀，\n\n06:34.243 --> 06:40.268\n胸部X线片、肺功能检查、心电图以及其他的头颅影像学的检查，\n\n06:40.268 --> 06:41.192\n头颅CT啊，\n\n06:41.192 --> 06:43.192\n还有鼻咽镜检查。\n\n06:43.342 --> 06:44.118\n最重要的是，\n\n06:44.118 --> 06:46.717\n我们要做多导睡眠监测，\n\n06:46.717 --> 06:47.906\nPSG它是金标准，\n\n06:47.906 --> 06:50.292\n确定它的类型及病情的轻重。\n\n06:54.291 --> 06:54.891\n嗯，\n\n06:54.891 --> 06:57.217\nPSG里面我们一般会包含脑电图，\n\n06:57.217 --> 07:01.992\n就是会有脑电、眼电、肌电、心电这些都包含在里面的。\n\n07:02.141 --> 07:05.217\n还有胸腹运动啊、氧饱和度、呼吸气流，\n\n07:05.217 --> 07:05.992\n还有汉音，\n\n07:06.291 --> 07:07.941\n我们都会包括在里面的。\n\n07:09.257 --> 07:09.507\n嗯。\n\n07:11.048 --> 07:13.298\n比较便携式的睡眠监测呢，\n\n07:13.298 --> 07:14.273\n是比较方便，\n\n07:14.273 --> 07:14.798\n但是。\n\n07:15.985 --> 07:16.286\n嗯，\n\n07:16.536 --> 07:19.186\n多导的话是比较准确的。\n\n07:19.877 --> 07:21.328\n便携式是可以带回家的，\n\n07:21.328 --> 07:23.428\n它作为诊断性的初筛工具，\n\n07:23.428 --> 07:26.078\n不能作为对患者详细评估的替代品，\n\n07:26.578 --> 07:28.352\n仅在下述情况下使用，\n\n07:28.352 --> 07:29.828\n比如睡眠呼吸暂停的，\n\n07:29.828 --> 07:31.102\n临床症状比较严重，\n\n07:31.102 --> 07:35.627\n急需开始治疗且不可能接受标准PSG检查的，\n\n07:35.627 --> 07:37.727\n不能在睡眠室内接受监测。\n\n07:38.395 --> 07:41.696\n第三是已经诊断并进行治疗的患者的随诊研究。\n\n07:52.024 --> 07:52.975\n我萨他的诊断，\n\n07:52.975 --> 07:57.524\n我们主要是根据他的典型的临床症状和体征。\n\n07:58.623 --> 07:58.824\n嗯，\n\n07:59.273 --> 08:00.648\n典型的临床症状呢，\n\n08:00.648 --> 08:02.799\n就比如他会主动会跟你说，\n\n08:02.799 --> 08:04.523\n他会有反复的睡眠打鼾，\n\n08:04.523 --> 08:06.799\n或者是他自己不知道家里人会怠速。\n\n08:06.799 --> 08:10.123\n就是说睡眠睡觉的过程中有呼吸暂停。\n\n08:11.364 --> 08:13.014\n不进期也不进不出去，\n\n08:13.014 --> 08:15.014\n令家家里人比较担心。\n\n08:15.463 --> 08:16.338\n还有一些呢，\n\n08:16.338 --> 08:17.914\n就是白天比较嗜睡，\n\n08:17.963 --> 08:22.289\n嗜睡的程度比较严重。\n\n08:22.289 --> 08:24.389\n就是有一些病人他很肥胖，\n\n08:24.389 --> 08:25.938\n就坐着说说着说着话，\n\n08:25.938 --> 08:26.889\n或者开着开着会，\n\n08:26.889 --> 08:27.764\n他就睡着了。\n\n08:28.402 --> 08:29.027\n还有一个就是，\n\n08:29.027 --> 08:30.902\n身体是比较肥胖的，\n\n08:31.302 --> 08:32.752\n颈围比较粗的。\n\n08:33.052 --> 08:33.452\n嗯，\n\n08:33.702 --> 08:34.776\n这些病人的话，\n\n08:34.776 --> 08:37.952\n他就是还有一个就记忆力减退。\n\n08:38.893 --> 08:39.093\n嗯。\n\n08:42.640 --> 08:42.841\n嗯，\n\n08:42.940 --> 08:45.216\n临床我们做了诊断以后，\n\n08:45.216 --> 08:49.491\n就要要给他做一个进一步的多导睡眠监测图。\n\n08:49.940 --> 08:50.666\n这个的话，\n\n08:50.666 --> 08:53.466\n是我们一般是在病房里睡一晚上，\n\n08:53.466 --> 08:56.291\n身上接上PSG的这些导联线。\n\n08:57.127 --> 08:57.377\n嗯。\n\n08:58.346 --> 08:59.747\n大于等于五次的话，\n\n08:59.747 --> 09:03.546\n每小时就可以确诊了。\n\n09:04.348 --> 09:07.547\n伴有日间症、嗜睡等症状就可以确诊。\n\n09:10.015 --> 09:12.414\n它的病因诊断就是，\n\n09:12.414 --> 09:19.565\n我们首先要详细的了解它的局部的解剖和发育的异常增生和肿瘤等。\n\n09:19.914 --> 09:26.414\n头颅颈部X线片、CT和磁共振测量口咽横截面积。\n\n09:27.297 --> 09:29.447\n可以作为狭窄的定位判断，\n\n09:29.648 --> 09:32.848\n对部分患者可以进行内分泌系统的测定。\n\n09:39.156 --> 09:42.706\n我们临床上就给病人做了PSG以后要给他打报告。\n\n09:43.057 --> 09:43.981\n打报告的话，\n\n09:43.981 --> 09:46.307\n我们就是要根据HR，\n\n09:46.307 --> 09:48.132\n也就在呼吸紊乱指数嘛，\n\n09:48.132 --> 09:50.557\n来给他分为轻中重。\n\n09:50.956 --> 09:54.456\n一般HR就是呼吸紊乱指数在5到十五呢，\n\n09:54.456 --> 09:55.856\n我们一般是轻度的，\n\n09:56.106 --> 09:57.456\n15到三十呢，\n\n09:57.456 --> 09:58.706\n一般是中度的，\n\n09:58.706 --> 10:01.557\n大于三十一般是就是重度的。\n\n10:02.252 --> 10:02.403\n嗯，\n\n10:02.403 --> 10:03.828\n同时它的氧饱和度呢，\n\n10:03.828 --> 10:04.653\n一般是。\n\n10:06.380 --> 10:07.380\n85到九十，\n\n10:07.380 --> 10:09.080\n我们是诊断是轻度的。\n\n10:09.280 --> 10:10.604\n80到八十五呢，\n\n10:10.604 --> 10:12.630\n一般是中中度低氧血症。\n\n10:12.929 --> 10:14.030\n小于八十的话，\n\n10:14.030 --> 10:16.030\n我们是诊断是重度的低氧血症。\n\n10:18.218 --> 10:19.494\n嗯，\n\n10:19.494 --> 10:22.419\nSPOR是为夜间最低的血氧饱和度。\n\n10:22.419 --> 10:24.018\nHR与SPOR的话，\n\n10:24.218 --> 10:26.468\n不一定是平级平级的。\n\n10:26.468 --> 10:28.544\n有的人可能是HR是比较低的，\n\n10:28.544 --> 10:31.843\n但是他的氧饱和度是比较低的。\n\n10:31.843 --> 10:32.593\n就是说，\n\n10:32.593 --> 10:34.318\n可能是轻度的阻塞性的，\n\n10:34.318 --> 10:36.818\n伴伴有重度的低氧血症，\n\n10:37.169 --> 10:39.843\n是不一定就是两个指标呀，\n\n10:39.843 --> 10:41.119\n不一定是平行的。\n\n10:42.562 --> 10:42.963\n嗯，\n\n10:42.963 --> 10:44.437\n中间我们还要说一下，\n\n10:44.437 --> 10:47.062\n就是中枢性的睡眠呼吸暂停。\n\n10:47.663 --> 10:48.062\n嗯，\n\n10:48.112 --> 10:49.812\n我们要知道他原发病的治疗，\n\n10:49.812 --> 10:50.987\n呼吸兴奋剂、药物，\n\n10:50.987 --> 10:52.862\n还有氧疗、辅助通气的治疗。\n\n10:55.737 --> 10:56.388\n中枢性的话，\n\n10:56.388 --> 11:00.937\n我们一般是用双水平的呼吸机治疗是比较多见的。\n\n11:01.768 --> 11:01.968\n嗯，\n\n11:02.268 --> 11:03.992\n然后o ss的话，\n\n11:03.992 --> 11:06.218\n我们一般是单水平的呼吸机治疗。\n\n11:08.486 --> 11:10.085\n还有一般的辅助治疗就是，\n\n11:10.885 --> 11:12.060\n如果比较肥胖的，\n\n11:12.060 --> 11:15.236\n我们会建议他适当的减肥运动。\n\n11:15.435 --> 11:15.835\n嗯，\n\n11:16.085 --> 11:17.935\n睡眠的时候有改变体位，\n\n11:18.236 --> 11:20.085\n就是或者侧着睡，\n\n11:20.085 --> 11:21.486\n就是不要平躺。\n\n11:21.935 --> 11:22.760\n还有一个呢，\n\n11:22.760 --> 11:24.185\n就戒烟戒酒。\n\n11:24.736 --> 11:28.460\n有些病人他劳累的时候或者喝酒的时候，\n\n11:28.460 --> 11:32.835\n他会觉得那天晚上他睡眠打鼾就是比较厉害。\n\n11:32.835 --> 11:33.435\n这个时候，\n\n11:33.435 --> 11:34.786\n我们最好是戒烟戒酒，\n\n11:34.786 --> 11:36.085\n床头抬高一点。\n\n11:36.715 --> 11:39.164\n还有最重要就是避免服用镇静的药，\n\n11:39.164 --> 11:40.989\n有些病人就是还吃安眠药，\n\n11:40.989 --> 11:42.114\n这是很危险的。\n\n11:45.612 --> 11:46.013\n嗯，\n\n11:46.062 --> 11:48.338\n治疗阻塞性的睡眠呼吸暂停呢，\n\n11:48.338 --> 11:51.163\n病因治疗是纠正他他的基础疾病，\n\n11:51.713 --> 11:54.013\n药物治疗效果不是很肯定的，\n\n11:54.013 --> 11:56.213\n目前也没有特效的药。\n\n11:56.213 --> 11:57.288\n如果是肥胖的话，\n\n11:57.288 --> 11:58.963\n你可能吃一点减肥的药。\n\n11:59.619 --> 12:01.219\n有利于减轻他这个睡眠，\n\n12:01.669 --> 12:02.070\n嗯，\n\n12:02.320 --> 12:03.219\n睡眠打鼾，\n\n12:03.419 --> 12:04.669\n还有一些就是，\n\n12:05.520 --> 12:05.919\n嗯，\n\n12:06.119 --> 12:06.919\n如果是。\n\n12:08.517 --> 12:13.216\n就是有一些病人很难通过节食来减肥，\n\n12:13.517 --> 12:13.916\n嗯，\n\n12:14.317 --> 12:18.966\n有少数的病人可以通过手术把胃切掉2/3呀。\n\n12:18.966 --> 12:20.267\n我以前也遇到过的，\n\n12:20.267 --> 12:20.666\n嗯，\n\n12:20.767 --> 12:21.617\n就可以。\n\n12:23.244 --> 12:23.945\n就可以减肥，\n\n12:23.994 --> 12:25.294\n达到减肥的效果。\n\n12:26.242 --> 12:26.593\n然后，\n\n12:26.593 --> 12:27.242\n同时呢，\n\n12:27.242 --> 12:29.492\n他的睡眠呼吸暂停也会得到改善。\n\n12:30.192 --> 12:32.543\n还有一个就口腔矫正器的治疗，\n\n12:33.543 --> 12:33.942\n嗯，\n\n12:33.942 --> 12:35.518\n最后就是手术的治疗，\n\n12:35.518 --> 12:37.543\n比如如果是鼻翼的手术啊。\n\n12:38.598 --> 12:41.098\n腭垂、软腭咽成形术，\n\n12:41.398 --> 12:48.348\n还有激光辅助咽成形术、低温射频消融、任何手术等。\n\n12:55.585 --> 12:55.935\n嗯，\n\n12:55.935 --> 12:58.260\n治疗阻塞型的SS的话，\n\n12:58.260 --> 13:01.236\n我们最主要就是无创正压通气治疗。\n\n13:01.435 --> 13:04.085\n这个一般无创指的是单水平的，\n\n13:04.085 --> 13:06.986\n不是呼吸科常见的那种双水平的呼吸机，\n\n13:06.986 --> 13:08.685\n这是单水平啊，\n\n13:08.685 --> 13:13.236\n经鼻持续正压内气气正压通气叫C盘，\n\n13:13.835 --> 13:18.260\n双水平的内双水平气道内正压通气叫白帕。\n\n13:18.260 --> 13:21.111\n我们一般是慢性呼吸衰竭的病人，\n\n13:21.111 --> 13:23.210\n或者是中枢性呕，\n\n13:23.210 --> 13:25.585\n睡眠呼吸暂停的病人用这个双水平。\n\n13:27.960 --> 13:29.609\n有个自动调压智能的。\n\n13:30.396 --> 13:32.447\nAuto呼吸机的治疗。\n\n13:35.689 --> 13:38.338\n无创呼吸机它的注意事项，\n\n13:38.689 --> 13:40.364\n使用无创呼吸机时，\n\n13:40.364 --> 13:42.189\n首先要改善它的。\n\n13:43.018 --> 13:44.268\n鼻腔通气情况。\n\n13:45.302 --> 13:47.203\n定要选择合适的面罩，\n\n13:47.403 --> 13:51.153\n面罩要求要柔软、舒适、可变可变形，\n\n13:51.203 --> 13:52.478\n密闭性要良好。\n\n13:52.478 --> 13:55.728\n气候干燥时要选用湿化器，\n\n13:55.728 --> 13:58.403\n在冬天还可以选择恒温的湿化器。\n\n14:00.297 --> 14:01.898\n口腔矫正器或牙托。\n\n14:04.036 --> 14:04.236\n嗯，\n\n14:04.236 --> 14:05.935\n这个是可以选用。\n\n14:07.500 --> 14:09.349\n饮酒以后打呼噜，\n\n14:09.349 --> 14:11.200\n睡眠质量改善了。\n\n14:11.200 --> 14:13.900\n入睡困难是现在都市人的常见病，\n\n14:14.000 --> 14:18.349\n不少人深信睡前来一杯酒能让他快速入入睡。\n\n14:18.849 --> 14:19.700\n那殊不知，\n\n14:19.700 --> 14:22.150\n酒精也许可以令你昏昏欲睡，\n\n14:22.150 --> 14:25.599\n但是酒精并不能保证人体所需的高质量的睡眠。\n\n14:26.000 --> 14:27.224\n饮用酒精以后，\n\n14:27.224 --> 14:30.200\n会使你的咽后壁肌肉松弛，\n\n14:30.250 --> 14:34.950\n这样患有睡眠呼吸暂停的患者更容易出现气道的阻塞。\n\n14:35.672 --> 14:37.922\n安眠药也有同样的临床副作用，\n\n14:37.922 --> 14:40.672\n所以还是不要喝酒，\n\n14:40.672 --> 14:41.773\n不要吃安眠药。\n\n14:43.512 --> 14:46.336\n睡眠呼吸暂停在儿童中发病率较低吗？\n\n14:46.336 --> 14:46.836\n其实O，\n\n14:46.836 --> 14:49.461\nSS在儿童发病率也是比较普遍的，\n\n14:49.762 --> 14:54.861\n在美国统计每十名儿童就表现为睡眠呼吸暂停的症状，\n\n14:54.861 --> 14:57.562\n主要是因为排除先天性的发育因素外，\n\n14:57.711 --> 14:59.961\n儿童肥胖的发病率也日益增多，\n\n14:59.961 --> 15:01.111\n因此儿童五十，\n\n15:01.111 --> 15:02.762\n11的患者也越来越多。\n\n15:03.211 --> 15:04.687\n相对来说，\n\n15:04.687 --> 15:07.361\n大多数的儿童病例临床表现比较轻。\n\n15:07.661 --> 15:08.586\n你记忆力差，\n\n15:08.586 --> 15:11.262\n精神不集中、学习成绩下降等表现，\n\n15:11.262 --> 15:13.711\n相当一部分的患儿表现出行为异常。\n\n15:13.786 --> 15:17.062\n常有其他的严重的临床并发症，\n\n15:17.062 --> 15:18.986\n比如像是腺样体肥大呀，\n\n15:19.036 --> 15:21.286\n他晚上睡觉的时候会翻来翻去，\n\n15:21.836 --> 15:26.512\n会跟你说他鼻子塞透不过气这些症状，\n\n15:26.512 --> 15:29.786\n还有一些就是肥胖的儿童也越来越多，\n\n15:29.937 --> 15:31.536\n所以o SARS的患者，\n\n15:31.536 --> 15:33.336\n小患者也是越来越多。\n\n15:34.137 --> 15:36.161\n减轻体重能缓解症状吗？\n\n15:36.161 --> 15:37.586\n这个观点是正确的。\n\n15:39.062 --> 15:42.213\n患者必须为改善呼吸睡眠暂停的症状，\n\n15:42.213 --> 15:44.963\n来对自己的生活方式进行必须的调整。\n\n15:44.963 --> 15:46.413\n比如患者要超重啊，\n\n15:46.413 --> 15:51.263\n去咨询医生以后要严格执行减重的饮食运动方案。\n\n15:51.991 --> 15:52.640\n临床结果。\n\n15:54.327 --> 15:56.202\n表明即使体重下降，\n\n15:56.202 --> 15:58.377\n仅占总体重的较小比例，\n\n15:58.377 --> 16:02.127\n仍然会较为显著的改善呼吸睡眠暂停的症状，\n\n16:02.526 --> 16:07.677\n尽可能的戒烟也会在极大程度上缓解呼吸睡眠暂停的症状。\n\n16:08.411 --> 16:11.361\n侧卧有助于减轻睡眠呼吸暂停的症状呢，\n\n16:11.361 --> 16:12.361\n正常情况下，\n\n16:12.611 --> 16:15.062\n侧卧位下因为重力的影响，\n\n16:15.062 --> 16:17.786\n肌肉组织自然向咽喉壁下垂，\n\n16:17.786 --> 16:20.562\n这样导致呼吸阻力的几率较大，\n\n16:20.861 --> 16:24.137\n侧卧位从很大程度上有助于克服这种困难，\n\n16:24.137 --> 16:26.062\n有助于保持气道的通畅。\n\n16:26.062 --> 16:29.512\n睡眠打鼾的患者建议还是侧卧位比较好，\n\n16:29.961 --> 16:33.586\n患者可以使用一些靠枕或者其他的辅助设施，\n\n16:33.586 --> 16:34.887\n背部放置网球，\n\n16:34.887 --> 16:37.211\n保持侧卧位睡眠。\n\n16:37.961 --> 16:41.236\n在日常医疗工作中需要高度警惕的事情，\n\n16:41.236 --> 16:53.411\n对于控制的难以控制的高血压合并肥胖、顽固性高血压或隐匿性高血压、清晨高血压或血压节律呈非勺型或反勺型改变的高血压患者。\n\n16:55.132 --> 16:56.356\n睡眠过程中有打鼾，\n\n16:56.356 --> 16:57.507\n白天嗜睡明显，\n\n16:57.507 --> 17:00.231\n夜间反复发作的难以控制的心绞痛，\n\n17:00.481 --> 17:02.856\n夜间发生且难以纠正的心律失常，\n\n17:02.856 --> 17:05.182\n顽固性的充血性的心力衰竭，\n\n17:05.381 --> 17:08.082\n顽固性难治性的糖尿病及胰岛素抵抗。\n\n17:08.082 --> 17:09.707\n不明原因的肺动脉高压，\n\n17:09.707 --> 17:14.682\n不明原因以夜间憋醒或夜间发作为主表现的发作性疾病。\n\n17:15.131 --> 17:17.107\n总结一下就是睡眠呼吸暂停，\n\n17:17.107 --> 17:20.482\n低通气综合症严严重危害人体的健康，\n\n17:20.482 --> 17:22.031\n甚至会危及你的生命的。\n\n17:23.131 --> 17:28.281\n严重疾患虽然现在有可提供选择的多种治疗方法，\n\n17:28.281 --> 17:31.756\n但是健康的生活方式和早期的正确的诊断，\n\n17:31.756 --> 17:35.881\n是预防和减少睡眠呼吸暂停及其并发症的关键。\n\n17:37.887 --> 17:38.437\n谢谢大家。\n\n","v0247cg10004d76e1l2ljht4u8q57utg",1059,571,0,"2026-01-25 00:01:34","睡眠呼吸综合征 - 症状、原因与治疗方法全解析  ","睡眠呼吸综合征,睡眠呼吸暂停,打鼾治疗,睡眠障碍,呼吸暂停症状,CPAP治疗  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