Scala Raffaele, Turkington Peter M, Wanklyn Peter, Bamford John, Elliott Mark W
Unità Operativa di Pneumologia, Endoscopia Toracica e UTSIR, Ospedale San Donato ASL8, Via Pietro Nenni, 20, 52100, Arezzo, Italy.
Respir Med. 2009 Jan;103(1):59-66. doi: 10.1016/j.rmed.2008.08.002. Epub 2008 Sep 18.
To evaluate the acceptance, effectiveness in preventing upper airways obstruction, and haemodynamic effects of continuous positive airway pressure (CPAP) in acute stroke.
Twelve patients (4 M, and 8 F; mean (SD), 75.2 (5.5) years) within 48 h of acute stroke onset underwent: (1) sleep studies (1st night: auto-CPAP mode; 2nd night: diagnostic); (2) nocturnal non-invasive blood pressure studies (1st night during CPAP; 2nd night during spontaneous breathing (SB)); and (3) daytime cerebral blood flow velocity measurement in middle cerebral artery (FV) with transcranial Doppler during SB and with CPAP (5, 10, 15 cm H(2)O).
Ninety percent, 60% and 50% of stroke patients had a respiratory disturbance index (RDI) of >or=5, >or=10 and >or=15 events per hour, respectively (18.2 (11.3)). CPAP acceptance was 84%; 42% used CPAP more than 6h and 42% between 1-3h with a mean use of CPAP of 5.2h (4.0). Compared to SB, CPAP reduced, though not significantly, RDI, time with SaO(2)<90%, mean blood pressure and mean blood pressure dips (10 mm Hg)/h. Compared with SB, any level of CPAP progressively and significantly reduced systolic and mean FV; drop in diastolic FV was significant at CPAP10 and CPAP15. The partial pressure of end-tidal CO(2) was significantly lowered by all levels of CPAP.
According to this pilot study, CPAP is reasonably well tolerated by patients with acute stroke for at least one night. Despite its possible beneficial effect on obstructive sleep-disordered breathing and blood pressure variability, CPAP use in acute stroke should be still considered with caution due to possible harmful haemodynamic effects at higher pressures.
评估持续气道正压通气（CPAP）在急性卒中患者中的接受程度、预防上气道梗阻的有效性及血流动力学效应。
12例急性卒中发病48小时内的患者（4例男性，8例女性；平均（标准差）年龄75.2（5.5）岁）接受了以下检查：（1）睡眠研究（第1晚：自动CPAP模式；第2晚：诊断性）；（2）夜间无创血压研究（第1晚CPAP期间；第2晚自主呼吸（SB）期间）；（3）在SB和CPAP（5、10、15 cm H₂O）状态下，采用经颅多普勒测量大脑中动脉的日间脑血流速度（FV）。
分别有90%、60%和50%的卒中患者呼吸紊乱指数（RDI）每小时≥5次、≥10次和≥15次事件（18.2（11.3））。CPAP的接受率为84%；42%的患者使用CPAP超过6小时，42%的患者使用1 - 3小时，CPAP平均使用时间为5.2小时（4.0）。与SB相比，CPAP虽未显著降低RDI、SaO₂<90%的时间、平均血压及平均血压下降幅度（10 mmHg/h）。与SB相比，任何水平的CPAP均可使收缩期和平均FV逐渐且显著降低；在CPAP 10和CPAP 15时，舒张期FV下降显著。所有水平的CPAP均可使呼气末二氧化碳分压显著降低。
根据这项初步研究，急性卒中患者对CPAP至少能耐受一晚。尽管CPAP对阻塞性睡眠呼吸障碍和血压变异性可能有益，但由于较高压力下可能产生有害的血流动力学效应，在急性卒中患者中使用CPAP仍应谨慎考虑。
