经静脉膈神经刺激治疗充血性心力衰竭伴陈-施呼吸患者：安全性和概念验证研究。

Transvenous phrenic nerve stimulation in patients with Cheyne-Stokes respiration and congestive heart failure: a safety and proof-of-concept study.

机构信息

Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Surgery, and Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.

出版信息

Chest. 2012 Oct;142(4):927-934. doi: 10.1378/chest.11-1899.

DOI:10.1378/chest.11-1899

PMID:22302299

Abstract

BACKGROUND

Cheyne-Stokes respiration (CSR), which often occurs in patients with congestive heart failure (CHF), may be a predictor for poor outcome. Phrenic nerve stimulation (PNS) may interrupt CSR in patients with CHF. We report the clinical use of transvenous PNS in patients with CHF and CSR.

METHODS

Nineteen patients with CHF and CSR were enrolled. A single stimulation lead was placed at the junction between the superior vena cava and brachiocephalic vein or in the left-side pericardiophrenic vein. PNS stimulation was performed using Eupnea System device (RespiCardia Inc). Respiratory properties were assessed before and during PNS. PNS was assessed at a maximum of 10 mA.

RESULTS

Successful stimulation capture was achieved in 16 patients. Failure to capture occurred in three patients because of dislocation of leads. No adverse events were seen under maximum normal stimulation parameters for an overnight study. When PNS was applied following a series of central sleep apneic events, a trend toward stabilization of breathing and heart rate as well as improvement in oxygen saturation was seen. Compared with pre-PNS, during PNS there was a significant decrease in apnea-hypopnea index (33.8 ± 9.3 vs 8.1 ± 2.3, P = .00), an increase in mean and minimal oxygen saturation as measured by pulse oximetry (89.7% ± 1.6% vs 94.3% ± 0.9% and 80.3% ± 3.7% vs 88.5% ± 3.3%, respectively, all P = .00) and end-tidal CO2 (38.0 ± 4.3 mm Hg vs 40.3 ± 3.1 mm Hg, P = .02), but no significant difference in sleep efficiency (74.6% ± 4.1% vs 73.7% ± 5.4%, P = .36).

CONCLUSIONS

The preliminary results showed that in a small group of patients with CHF and CSR, 1 night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.

摘要

背景

潮式呼吸（CSR）常发生于充血性心力衰竭（CHF）患者，可能是预后不良的预测因素。膈神经刺激（PNS）可能会中断 CHF 患者的 CSR。我们报告了经静脉 PNS 在 CHF 合并 CSR 患者中的临床应用。

方法

19 例 CHF 合并 CSR 患者入组。单个刺激导联置于上腔静脉和头臂静脉交界处或左侧心包膜下冠状静脉。使用 Eupnea System 设备（RespiCardia Inc）进行 PNS 刺激。在 PNS 前后评估呼吸特性。PNS 刺激最高可达 10 mA。

结果

16 例患者成功获得刺激捕获。由于导联脱位，3 例患者未能捕获。在一夜的正常最大刺激参数研究中，未见不良事件。当 PNS 在一系列中枢性睡眠呼吸暂停事件后应用时，呼吸和心率趋于稳定，氧饱和度改善。与 PNS 前相比，PNS 时呼吸暂停低通气指数显著降低（33.8 ± 9.3 比 8.1 ± 2.3，P =.00），脉搏血氧饱和度仪测量的平均和最小氧饱和度增加（89.7% ± 1.6% 比 94.3% ± 0.9% 和 80.3% ± 3.7% 比 88.5% ± 3.3%，均 P =.00），呼气末二氧化碳分压降低（38.0 ± 4.3 mmHg 比 40.3 ± 3.1 mmHg，P =.02），但睡眠效率无显著差异（74.6% ± 4.1% 比 73.7% ± 5.4%，P =.36）。