呼吸驱动和呼吸模式异常与慢性心力衰竭患者的运动不耐受有关。

Respiratory drive and breathing pattern abnormalities are related to exercise intolerance in chronic heart failure patients.

机构信息

1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio" Hospital, NKUA, Athens, Greece.

3rd Cardiology Department, "Laiko" Hospital, NKUA, Athens, Greece.

出版信息

Respir Physiol Neurobiol. 2014 Feb 1;192:90-4. doi: 10.1016/j.resp.2013.11.011. Epub 2013 Dec 17.

DOI:10.1016/j.resp.2013.11.011

PMID:24361502

Abstract

BACKGROUND

Patients with chronic heart failure (CHF) are characterized by exercise intolerance and ventilatory abnormalities that are related to poor prognosis. We hypothesized that CHF patients have increased respiratory drive and abnormal breathing pattern during exercise in relation to disease severity.

MATERIALS AND METHODS

The study population consisted of 219 stable CHF patients and 30 healthy control subjects. All subjects underwent a symptom-limited cardiopulmonary exercise testing (CPET), pulmonary function tests, measurement of the maximal inspiratory pressure (PImax) and respiratory drive (P0.1). Measurements included peak oxygen uptake ( [Formula: see text] peak, ml/kg/min). Respiratory drive was measured by mouth occlusion pressure P0.1 and P0.1/PImax ratio at rest, and by mean inspiratory flow (VT/TI) at rest and during exercise. CHF patients were divided into 3 groups according to [Formula: see text] peak (Group A: >20, Group B: 20-16 and Group C: <16ml/kg/min).

RESULTS

CHF patients presented higher P0.1/PImax (4.1±3.6 vs 3.0±1.5, p=0.007) and VT/TI at rest (0.48±0.14 vs 0.41±0.10, L/s respectively, p=0.004) and lower VT/TI at peak exercise (2.17±0.66 vs 2.56±0.73, L/s, p=0.009) compared to controls. P0.1/PImax was higher in CHF Group C vs B vs A (4.9±2.9 vs 3.6±1.8 vs 3.1±1.8, respectively, p<0.001), while VT/TI at peak exercise was lower (1.71±0.43 vs 2.15±0.52 vs 2.65±0.64, L/s, respectively, p<0.001).

CONCLUSIONS

CHF patients present increased respiratory drive at rest and abnormal breathing pattern during exercise in relation to CHF severity.

摘要

背景

慢性心力衰竭（CHF）患者的特点是运动不耐受和通气异常，这与预后不良有关。我们假设 CHF 患者在运动时呼吸驱动增加和呼吸模式异常与疾病严重程度有关。

材料和方法

研究人群包括 219 例稳定的 CHF 患者和 30 名健康对照者。所有受试者均进行了症状限制心肺运动测试（CPET）、肺功能测试、最大吸气压力（PImax）和呼吸驱动（P0.1）的测量。测量指标包括峰值摄氧量（[Formula: see text]peak，ml/kg/min）。呼吸驱动通过口腔阻断压 P0.1 和 P0.1/PImax 比值在休息时，以及平均吸气流量（VT/TI）在休息和运动时进行测量。根据[Formula: see text]peak 将 CHF 患者分为 3 组（A 组：>20，B 组：20-16，C 组：<16ml/kg/min）。

结果

CHF 患者的 P0.1/PImax（4.1±3.6 比 3.0±1.5，p=0.007）和休息时的 VT/TI（0.48±0.14 比 0.41±0.10，L/s，p=0.004）更高，而峰值运动时的 VT/TI 更低（2.17±0.66 比 2.56±0.73，L/s，p=0.009）。与对照组相比。CHF 组 C 的 P0.1/PImax 高于 B 组和 A 组（4.9±2.9 比 3.6±1.8 比 3.1±1.8，p<0.001），而峰值运动时的 VT/TI 较低（1.71±0.43 比 2.15±0.52 比 2.65±0.64，L/s，p<0.001）。