清醒振荡通气在心力衰竭患者中的临床意义及心脏直视手术的影响。
Clinical significance of awake oscillatory ventilation in patients with heart failure and effects of open-heart surgery.
机构信息
EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan. k
出版信息
Clin Cardiol. 2010 Jul;33(7):E20-3. doi: 10.1002/clc.20572.
BACKGROUND
Although sleep apnea has recently become a concern in patients with congestive heart failure (CHF), some patients with CHF exhibit characteristic oscillatory ventilation (OV) even when they are awake. We investigated the clinical significance of OV in patients with CHF, and effects of open-heart surgery on the OV.
HYPOTHESIS
OV is an indicator of the severity of CHF, and this abnormal respiratory pattern improves with hemodynamic changes after open-heart surgery.
METHODS
According to respiratory pattern in the cardiopulmonary exercise testing (CPX) before cardiac surgery, 50 patients with CHF were divided into 14 patients of OV-positive (OV+) and 36 patients of OV-negative (OV-). Then, the several indices of CPX before surgery, 1 week and 6 months after surgery were compared between the 2 groups.
RESULTS
The peak VO2 before surgery was lower in OV+ patients than those in OV- patients (15.3 vs 18.8 m1/min/kg, p < 0.05). One week after surgery, anaerobic threshold (AT) and end-tidal C02 (ETC02) were lower in OV+ patients than those in OV- patients (AT: 9.5 vs 10,7 ml/min/kg, p < 0.05, ETCO2: 5.3 vs 5.6%, p < 0.05). However, 6 months after surgery, the statistical differences of these CPX parameters between the 2 groups were not found, and OV disappeared in 79% of OV+ patients.
CONCLUSIONS
These data suggest that OV is an indicator of the severity of CHF, and gradually improved with the open-heart surgery.
背景
尽管睡眠呼吸暂停症最近成为充血性心力衰竭（CHF）患者关注的焦点，但一些 CHF 患者即使在清醒时也会表现出特征性的振荡性通气（OV）。我们研究了 CHF 患者 OV 的临床意义，以及心脏直视手术后对 OV 的影响。
假说
OV 是 CHF 严重程度的一个指标，这种异常呼吸模式在心脏直视手术后随着血液动力学变化而改善。
方法
根据心脏手术前心肺运动测试（CPX）中的呼吸模式，将 50 例 CHF 患者分为 OV 阳性（OV+）组 14 例和 OV 阴性（OV-）组 36 例。然后，比较两组患者术前、术后 1 周和 6 个月的 CPX 多项指标。
结果
OV+患者术前峰值 VO2 低于 OV-患者（15.3 比 18.8ml/min/kg，p<0.05）。术后 1 周，OV+患者的无氧阈值（AT）和呼气末 CO2（ETC02）低于 OV-患者（AT：9.5 比 10.7ml/min/kg，p<0.05，ETCO2：5.3 比 5.6%，p<0.05）。然而，术后 6 个月，两组间 CPX 各项参数的差异均无统计学意义，OV+患者中有 79%的患者 OV 消失。
结论
这些数据表明，OV 是 CHF 严重程度的一个指标，并且随着心脏直视手术而逐渐改善。
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