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目的 探讨哮喘患儿有夜间哮喘发作、且不易控制的原因和机制。方法 对 14例有夜间发作及 8例无夜间发作的两组哮喘患儿进行睡眠呼吸监测 ,同时测定监测当天入睡前、次日起床、起床后 3h时的最大呼气流速 (PEFR)并进行分析。结果 两组比较 ,夜间哮喘发作组呼吸暂停低通气指数 (AHI)较高 (P <0 0 5 ) ,其中有 4例AHI≥ 5 ;最低氧饱和度 (LSaO2 )、氧饱和度≤ 0 90的时间占总监测时间的百分比 (SIT90 )及 (Ⅰ +Ⅱ )期、(Ⅲ +Ⅳ )期睡眠和快动眼睡眠期所占的时间及觉醒指数 ,两组比较 ,均有显著差异 (P <0 0 1) ;夜间哮喘发作组起床时的PEFR值较入睡前降低 (P <0 0 5 ) ,后又迅速恢复正常 ,非夜间哮喘发作组则无变化。结论 合并有阻塞性睡眠呼吸暂停综合征 (OSAS)、严重打鼾及睡眠低氧是诱发夜间哮喘发作的主要原因 ,其机制与气道狭窄、迷走神经张力升高、神经反射机制有关 ,睡眠结构发生变化是机体的一种保护性机制
Objective To investigate the causes and mechanisms of asthma attacks in children with nocturnal asthma attacks. Methods 14 patients with nocturnal episodes and 8 nocturnal episodes of asthma were monitored for sleep respiration, and the maximum expiratory flow rate (PEFR) before going to sleep on the day of monitoring, on the next day, at 3 h after getting up, and then analyzed . Results Compared with the two groups, the nighttime asthma attack group had higher AHI (P <0 05), of which 4 cases had AHI≥5; the lowest oxygen saturation (LSaO2), the oxygen saturation less than 0 90 (SIT90) and (Ⅰ + Ⅱ), (Ⅲ + Ⅳ) sleep and rapid eye movement sleep time and awakening index, the two groups were significantly different (P < The PEFR value of the asthma attack group was significantly lower than that of the asthma attack group before going to sleep (P <0.05), and then quickly returned to normal. There was no change in non-nocturnal asthma attack group. Conclusions OSAS, severe snoring and sleep hypoxia are the main causes of nocturnal asthma attacks. The mechanisms are related to airway stenosis, vagal tone increase and neural reflex mechanism, and the changes of sleep structure Is a protective mechanism of the body