适应性伺服通气对充血性心力衰竭和陈-施呼吸患者的疗效。

Efficacy of adaptive servoventilation in patients with congestive heart failure and Cheyne-Stokes respiration.

作者信息

Zhang Xi-long, Yin Kai-sheng, Li Xin-li, Jia En-zhi, Su Mei

机构信息

Department of Respiratory Diseases, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.

出版信息

Chin Med J (Engl). 2006 Apr 20;119(8):622-7.

PMID:16635405

Abstract

BACKGROUND

Congestive heart failure (CHF) is associated with Cheyne-Stokes respiration (CSR), which may hasten CHF. Adaptive servoventilation (ASV) is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy.

METHODS

Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items: a) parameters of sleep respiration, sleep structure and quality; b) left ventricle ejection fraction (LVEF) and 6-minute walk distance.

RESULTS

Compared with the baseline levels of apnoea hypopnoea index of 34.5 +/- 6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8 +/- 8.2, P < 0.05 and further reduced following ASV treatment to 6.5 +/- 0.8, P < 0.01. The minimal pulse oxygen saturation markedly increased following oxygen therapy from a baseline of (84.3 +/- 2.6)% to (88.6 +/- 3.7)%, P < 0.05 and further increased following ASV treatment (92.1 +/- 4.9)%, P < 0.01. Stages I + II sleep as percentage of total sleep time decreased from (81.9 +/- 7.1)% to (78.4 +/- 6.7)% following oxygen therapy and further to (72.4 +/- 5.0)% following ASV treatment. Stages III + IV sleep as percentage of total sleep time decreased from (8.4 +/- 5.5)% to (6.0 +/- 3.0)% following oxygen therapy and but increased to (11.9 +/- 5.4)% following ASV treatment. The arousal index of 30.4 +/- 8.1 before treatment significantly decreased following oxygen therapy to 25.6 +/- 5.7, P < 0.05 and further declined following ASV treatment to 18.2 +/- 6.1, P < 0.01. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment (P > 0.05). LVEF was significantly higher on day 14 of ASV treatment (37.2 +/- 4.1)% than on day 14 of oxygen therapy (33.2 +/- 5.1)% and before treatment (30.2 +/- 4.6)% (all P < 0.05). Six-minute walk distance was the shortest before treatment (226 +/- 28) m, longer on day 14 of oxygen therapy (289 +/- 26) m, and the longest on day 14 of ASV treatment (341 +/- 27) m (all P < 0.01).

CONCLUSION

ASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.

摘要

背景

充血性心力衰竭（CHF）与潮式呼吸（CSR）相关，CSR可能会加速CHF的发展。适应性伺服通气（ASV）是一种新型的通气支持方法，旨在消除CHF患者的CSR。本研究比较了ASV对CHF合并CSR患者的疗效与氧疗的疗效。

方法

招募了14例CHF合并CSR患者。在睡眠期间，分别进行为期两周的鼻导管吸氧治疗和ASV治疗。对每种治疗前后的以下项目进行比较：a）睡眠呼吸参数、睡眠结构和质量；b）左心室射血分数（LVEF）和6分钟步行距离。

结果

与治疗前呼吸暂停低通气指数的基线水平34.5±6.1相比，氧疗后呼吸暂停低通气指数显著降低至27.8±8.2，P<0.05，ASV治疗后进一步降至6.5±0.8，P<0.01。最低脉搏血氧饱和度在氧疗后从基线水平（84.3±2.6）%显著升至（88.6±3.7）%，P<0.05，ASV治疗后进一步升至（92.1±4.9）%，P<0.01。I+II期睡眠占总睡眠时间的百分比在氧疗后从（81.9±7.1）%降至（78.4±6.7）%，ASV治疗后进一步降至（72.4±5.0）%。III+IV期睡眠占总睡眠时间的百分比在氧疗后从（8.4±5.5）%降至（6.0±3.0）%，但在ASV治疗后升至（11.9±5.4）%。治疗前觉醒指数为30.4±8.1，氧疗后显著降至25.6±5.7，P<0.05，ASV治疗后进一步降至18.2±6.1，P<0.01。氧疗第14天与治疗前相比，上述百分比无显著差异（P>0.05）。ASV治疗第14天的LVEF（37.2±4.1）%显著高于氧疗第14天（33.2±5.1）%和治疗前（30.2±4.6）%（均P<0.05）。6分钟步行距离在治疗前最短（226±28）m，氧疗第14天延长至（289±26）m，ASV治疗第14天最长（341±27）m（均P<0.01）。