乙酰唑胺和吸入二氧化碳可减少慢性心力衰竭患者运动期间的周期性呼吸。

Acetazolamide and inhaled carbon dioxide reduce periodic breathing during exercise in patients with chronic heart failure.

作者信息

Apostolo Anna, Agostoni Piergiuseppe, Contini Mauro, Antonioli Laura, Swenson Erik R

机构信息

Centro Cardiologico Monzino, IRCCS, Milan, Italy.

Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

出版信息

J Card Fail. 2014 Apr;20(4):278-88. doi: 10.1016/j.cardfail.2014.01.007. Epub 2014 Jan 10.

DOI:10.1016/j.cardfail.2014.01.007

PMID:24418726

Abstract

BACKGROUND

Periodic breathing (PB) during sleep and exercise in heart failure (HF) is related to respiratory acid-base status, CO2 chemosensitivity, and temporal dynamics of CO2 and O2 sensing. We studied inhaled CO2 and acetazolamide to alter these factors and reduce PB.

METHODS AND RESULTS

We measured expired and arterial gases and PB amplitude and duration in 20 HF patients during exercise before and after acetazolamide given acutely (500 mg intravenously) and prolonged (24 hours, 2 g orally), and we performed overnight polysomnography. We studied CO2 inhalation (1%-2%) during constant workload exercise. PB disappeared in 19/20 and 2/7 patients during 2% and 1% CO2. No changes in cardiorespiratory parameters were observed after acute acetazolamide. With prolonged acetazolamide at rest: ventilation +2.04 ± 4.0 L/min (P = .001), tidal volume +0.11 ± 1.13 L (P = .003), respiratory rate +1.24 ± 4.63 breaths/min (NS), end-tidal PO2 +4.62 ± 2.43 mm Hg (P = .001), and end-tidal PCO2 -2.59 ± 9.7 mm Hg (P < .001). At maximum exercise: Watts -10% (P < .02), VO2 -61 ± 109 mL/min (P = .04) and VCO2 101 ± 151 mL/min (P < .02). Among 20 patients, PB disappeared in 1 and 7 subjects after acute and prolonged acetazolamide, respectively. PB was present 80% ± 26, 65% ± 28, and 43% ± 39 of exercise time before and after acute and prolonged acetazolamide, respectively. Overnight apnea/hypopnea index decreased from 30.8 ± 83.8 to 21.1 ± 16.9 (P = .003).

CONCLUSIONS

In HF, inhaled CO2 and acetazolamide reduce exercise PB with additional benefits of acetazolamide on sleep PB.

摘要

背景

心力衰竭（HF）患者睡眠和运动期间的周期性呼吸（PB）与呼吸酸碱状态、二氧化碳化学敏感性以及二氧化碳和氧气传感的时间动态有关。我们研究了吸入二氧化碳和乙酰唑胺以改变这些因素并减少PB。

方法与结果

我们在20例HF患者急性（静脉注射500mg）和长期（24小时，口服2g）给予乙酰唑胺前后的运动期间测量呼出气体和动脉血气以及PB幅度和持续时间，并进行整夜多导睡眠图检查。我们在恒定工作量运动期间研究了吸入二氧化碳（1%-2%）。在吸入2%和1%二氧化碳期间，19/20和2/7的患者PB消失。急性给予乙酰唑胺后未观察到心肺参数的变化。长期服用乙酰唑胺后静息状态下：通气量增加2.04±4.0L/min（P=.001），潮气量增加0.11±1.13L（P=.003），呼吸频率增加1.24±4.63次/分钟（无统计学意义），呼气末氧分压增加4.62±2.43mmHg（P=.001），呼气末二氧化碳分压降低2.59±9.7mmHg（P<.001）。在最大运动时：瓦特数降低10%（P<.02），耗氧量降低61±109mL/min（P=.04），二氧化碳排出量降低101±151mL/min（P<.02）。在20例患者中，急性和长期给予乙酰唑胺后，分别有1例和7例患者的PB消失。急性和长期给予乙酰唑胺前后，PB分别占运动时间的80%±26%、65%±28%和43%±39%。整夜呼吸暂停/低通气指数从30.8±83.8降至21.1±16.9（P=.003）。