适应性压力支持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 pressure support servo-ventilation in patients with congestive heart failure and Cheyne-Stokes respiration].

作者信息

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

机构信息

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

出版信息

Zhonghua Yi Xue Za Zhi. 2006 Jun 20;86(23):1620-3.

PMID:16854301

Abstract

OBJECTIVE

To investigate the efficacy of adaptive pressure support servo-ventilation (APSSV) on Cheyne-Stokes respiration (CSR) in congestive heart failure (CHF).

METHODS

14 patients with CHF and CSR were recruited. During sleep, oxygen therapy and APSSV were separately performed. Comparison before and after each treatment was made for the following items: a) parameters of sleep respiration, sleep structure and quality; b) cardiac function index such as left ventricle ejection fraction (LVEF) and 6 minutes' walking distance; c) plasma endothelin-1 (ET-1) levels.

RESULTS

Compared with the baseline level before treatment, the apnea hypopnea index significantly decreased during oxygen therapy (P < 0.05) and further declined during APSSV (P < 0.01); on the contrary, the lowest pulse oxygen saturation increased during oxygen therapy (P < 0.05) and further elevated during APSSV (P < 0.01). Compared with arousal index before treatment, it was significantly lower during oxygen therapy (P < 0.05) and the lowest during APSSV (P < 0.01). Compared with both during oxygen therapy and before treatment, during APSSV the percentage ofI + II stage sleep time/total sleep time was significantly lower while the percentage of III + IV stage sleep time/total sleep time was significantly higher. The above percentages during oxygen therapy and before treatment showed no significant difference (P < 0.05). LVEF was significantly higher during APSSV than during oxygen therapy and before treatment (P < 0.05). Six minutes' walking distance was the shortest before treatment and the longest during APSSV. There was a significant difference among that before treatment, during oxygen therapy and APSSV (all P < 0.01). The plasma ET-1 level showed significantly lower during APSSV than that before and during oxygen treatment (P < 0.05), but no significant difference between the levels before and during oxygen treatment (P > 0.05).

CONCLUSION

APSSV, more effective than oxygen therapy, is of great clinical significance in improvement of CHF and its prognosis by a better sleep and breathing.

摘要

目的

探讨适应性压力支持伺服通气（APSSV）对充血性心力衰竭（CHF）患者潮式呼吸（CSR）的疗效。

方法

招募14例CHF合并CSR患者。在睡眠期间，分别进行氧疗和APSSV。对以下各项进行每次治疗前后的比较：a）睡眠呼吸、睡眠结构和质量参数；b）心功能指标，如左心室射血分数（LVEF）和6分钟步行距离；c）血浆内皮素-1（ET-1）水平。

结果

与治疗前基线水平相比，氧疗期间呼吸暂停低通气指数显著降低（P<0.05），APSSV期间进一步下降（P<0.01）；相反，最低脉搏血氧饱和度在氧疗期间升高（P<0.05），APSSV期间进一步升高（P<0.01）。与治疗前觉醒指数相比，氧疗期间显著降低（P<0.05），APSSV期间最低（P<0.01）。与氧疗期间和治疗前相比，APSSV期间I+II期睡眠时间/总睡眠时间百分比显著降低，而III+IV期睡眠时间/总睡眠时间百分比显著升高。氧疗期间和治疗前的上述百分比无显著差异（P<0.05）。APSSV期间LVEF显著高于氧疗期间和治疗前（P<0.05）。6分钟步行距离治疗前最短，APSSV期间最长。治疗前、氧疗期间和APSSV期间之间存在显著差异（均P<0.01）。APSSV期间血浆ET-1水平显著低于氧疗前和氧疗期间（P<0.05），但氧疗前和氧疗期间水平之间无显著差异（P>0.05）。