持续气道正压通气对慢性心力衰竭患者脉压的急性影响

Acute effects of continuous positive air way pressure on pulse pressure in chronic heart failure.

作者信息

Quintão Mônica, Chermont Sérgio, Marchese Luana, Brandão Lúcia, Bernardez Sabrina Pereira, Mesquita Evandro Tinoco, Novaes Rocha Nazareth de, Nóbrega Antônio Claudio L

机构信息

Universidade Federal Fluminense, RJ, Brasil.

Clinica de Insuficiencia Cardiaca, Centro Universitario Serra dos Orgaos, Teresopolis, RJ, Brasil.

出版信息

Arq Bras Cardiol. 2014 Feb;102(2):181-6. doi: 10.5935/abc.20140006.

DOI:10.5935/abc.20140006

PMID:24676373

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3987333/

Abstract

BACKGROUND

Patients with heart failure (HF) have left ventricular dysfunction and reduced mean arterial pressure (MAP). Increased adrenergic drive causes vasoconstriction and vessel resistance maintaining MAP, while increasing peripheral vascular resistance and conduit vessel stiffness. Increased pulse pressure (PP) reflects a complex interaction of the heart with the arterial and venous systems. Increased PP is an important risk marker in patients with chronic HF (CHF). Non-invasive ventilation (NIV) has been used for acute decompensated HF, to improve congestion and ventilation through both respiratory and hemodynamic effects. However, none of these studies have reported the effect of NIV on PP.

OBJECTIVE

The objective of this study was to determine the acute effects of NIV with CPAP on PP in outpatients with CHF.

METHODS

Following a double-blind, randomized, cross-over, and placebo-controlled protocol, twenty three patients with CHF (17 males; 60±11 years; BMI 29±5 kg/cm2, NYHA class II, III) underwent CPAP via nasal mask for 30 min in a recumbent position. Mask pressure was 6 cmH2O, whereas placebo was fixed at 0-1 cmH2O. PP and other non invasive hemodynamics variables were assessed before, during and after placebo and CPAP mode.

RESULTS

CPAP decreased resting heart rate (Pre: 72±9; vs. Post 5 min: 67±10 bpm; p<0.01) and MAP (CPAP: 87±11; vs. control 96±11 mmHg; p<0.05 post 5 min). CPAP decreased PP (CPAP: 47±20 pre to 38±19 mmHg post; vs. control: 42±12 mmHg, pre to 41±18 post p<0.05 post 5 min).

CONCLUSION

NIV with CPAP decreased pulse pressure in patients with stable CHF. Future clinical trials should investigate whether this effect is associated with improved clinical outcome.

摘要

背景

心力衰竭（HF）患者存在左心室功能障碍且平均动脉压（MAP）降低。肾上腺素能驱动增加会导致血管收缩和血管阻力，以维持MAP，同时增加外周血管阻力和管道血管僵硬度。脉压（PP）升高反映了心脏与动脉和静脉系统之间的复杂相互作用。PP升高是慢性心力衰竭（CHF）患者的重要风险标志物。无创通气（NIV）已用于急性失代偿性HF，通过呼吸和血流动力学效应改善充血和通气。然而，这些研究均未报告NIV对PP的影响。

目的

本研究的目的是确定持续气道正压通气（CPAP）的NIV对CHF门诊患者PP的急性影响。

方法

按照双盲、随机、交叉和安慰剂对照方案，23例CHF患者（17例男性；60±11岁；体重指数29±5kg/cm²，纽约心脏协会II级、III级）在卧位通过鼻罩接受CPAP治疗30分钟。面罩压力为6cmH₂O，而安慰剂固定在0-1cmH₂O。在安慰剂和CPAP模式之前、期间和之后评估PP和其他无创血流动力学变量。

结果

CPAP降低静息心率（治疗前：72±9；治疗后5分钟：67±10次/分钟；p<0.01）和MAP（CPAP：87±11；对照：96±11mmHg；治疗后5分钟p<0.05）。CPAP降低PP（CPAP：治疗前47±20至治疗后38±19mmHg；对照：治疗前42±12mmHg至治疗后41±18mmHg，治疗后5分钟p<0.05）。