经鼻双水平气道正压通气对伴有陈-施呼吸和中枢性睡眠呼吸暂停的充血性心力衰竭患者的疗效

Efficacy of nasal bi-level positive airway pressure in congestive heart failure patients with cheyne-stokes respiration and central sleep apnea.

作者信息

Kasai Takatoshi, Narui Koji, Dohi Tomotaka, Ishiwata Sugao, Yoshimura Kunihiko, Nishiyama Shin-Ichiro, Yamaguchi Tetsu, Momomura Shin-Ichi

机构信息

Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.

出版信息

Circ J. 2005 Aug;69(8):913-21. doi: 10.1253/circj.69.913.

DOI:10.1253/circj.69.913

PMID:16041159

Abstract

BACKGROUND

Cheyne - Stokes respiration with central sleep apnea (CSR-CSA) contributes to the poor prognosis in patients with congestive heart failure (CHF). Bi-level positive airway pressure (bi-level PAP) may be an effective alternative for treating CSR-CSA and CHF.

METHODS AND RESULTS

Fourteen patients with CSR-CSA were divided into 2 groups, a control group that included 7 patients who decided to receive only conventional medications and a group of 7 patients that received bi-level PAP. Left ventricular ejection fraction (LVEF), mitral regurgitation (MR) area, plasma brain natriuretic peptide (BNP) concentration and the New York Heart Association (NYHA) functional class were evaluated initially (baseline) and 3 months later. In the control group, there were no significant changes in cardiac function during the study period. In contrast, in the group that received bi-level PAP, there were significant improvements in LVEF (from 36.3+/-2.9% to 46.0+/-4.0%, p = 0.02), MR area (from 30.4+/-7.6% to 20.0+/-5.1%, p = 0.02), BNP (from 993.6+/-332.0 pg/ml to 474.0+/-257.6 pg/ml, p = 0.02) and NYHA functional class (from 3.1+/-0.1 to 2.1+/-0.1, p = 0.03).

CONCLUSION

Treatment with bi-level PAP improved cardiac functions in CHF patients with CSR-CSA.

摘要

背景

伴有中枢性睡眠呼吸暂停的陈-施呼吸（CSR-CSA）会导致充血性心力衰竭（CHF）患者预后不良。双水平气道正压通气（双水平PAP）可能是治疗CSR-CSA和CHF的一种有效替代方法。

方法与结果

14例CSR-CSA患者被分为2组，对照组包括7例决定仅接受传统药物治疗的患者，另一组7例患者接受双水平PAP治疗。在初始（基线）时和3个月后评估左心室射血分数（LVEF）、二尖瓣反流（MR）面积、血浆脑钠肽（BNP）浓度以及纽约心脏协会（NYHA）心功能分级。在对照组中，研究期间心脏功能无显著变化。相比之下，在接受双水平PAP治疗的组中，LVEF（从36.3±2.9%提高到46.0±4.0%，p = 0.02）、MR面积（从30.4±7.6%减小到20.0±5.1%，p = 0.02）、BNP（从993.6±332.0 pg/ml降至474.±257.6 pg/ml，p = 0.02）以及NYHA心功能分级（从3.1±0.1降至2.1±0.1，p = 0.03）均有显著改善。