Department of Cardiology, International Medical Centre, Saitama Medical University, Japan
Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University, Tokyo, Japan.
Eur Heart J Acute Cardiovasc Care. 2015 Aug;4(4):305-15. doi: 10.1177/2048872614549103. Epub 2014 Sep 1.
Adaptive servo-ventilation has a potential sympathoinhibitory effect in acute cardiogenic pulmonary oedema (ACPO).
To evaluate the acute effects of adaptive servo-ventilation in patients with ACPO.
Fifty-eight consecutive patients with ACPO were divided into those who underwent adaptive servo-ventilation and those who received oxygen therapy alone as part of their immediate care. Visual analogue scale, vital signs, blood gas data and plasma catecholamine concentrations at baseline and 1 h during emergency care, and subsequent clinical events (death within 30 days, intubation within seven days or between seven and 30 days, and length of hospital stay) were assessed. Pre-matched and post-propensity score (PS)-matched datasets were analysed.
During the first hour of adaptive servo-ventilation, plasma catecholamine concentrations fell significantly (baseline versus 1 h: epinephrine p = 0.003, norepinephrine p < 0.001, dopamine p < 0.001), with falls in blood pressure, heart rate, respiratory rate and pCO2, and rise in HCO3 and pH. In the PS-matched model, visual analogue scale (p = 0.036), systolic blood pressure (from 153.8 ± 30.7 to 133.1 ± 16.3 mmHg; p = 0.025) and plasma dopamine concentration (p = 0.034) fell significantly in the adaptive servo-ventilation group compared with the oxygen therapy alone group. The clinical outcomes between the groups were comparable.
In patients with ACPO, emergency care using adaptive servo-ventilation attenuated plasma catecholamine concentrations and led to the improvement of dyspnoea, vital signs and acid-base balance, without adversely influencing clinical outcomes. Using adaptive servo-ventilation, rather than standard oxygen alone, may relieve dyspnoea and improve haemodynamic status, possibly by modulating sympathetic nerve activity.
适应性伺服通气在急性心源性肺水肿（ACPO）中具有潜在的交感抑制作用。
评估适应性伺服通气在 ACPO 患者中的急性作用。
58 例连续的 ACPO 患者分为接受适应性伺服通气和仅接受氧气治疗的两组，作为其急救护理的一部分。在急救护理时，评估基线时和 1 小时时的视觉模拟量表、生命体征、血气数据和血浆儿茶酚胺浓度，以及随后的临床事件（30 天内死亡、7 天内插管或 7-30 天内插管、以及住院时间）。分析了预匹配和后倾向评分（PS）匹配数据集。
在适应性伺服通气的第一小时内，血浆儿茶酚胺浓度显著下降（基线与 1 小时：肾上腺素 p = 0.003，去甲肾上腺素 p < 0.001，多巴胺 p < 0.001），血压、心率、呼吸频率和 pCO2 下降，HCO3 和 pH 升高。在 PS 匹配模型中，与仅接受氧气治疗的组相比，自适应伺服通气组的视觉模拟量表（p = 0.036）、收缩压（从 153.8 ± 30.7 降至 133.1 ± 16.3 mmHg；p = 0.025）和血浆多巴胺浓度（p = 0.034）显著下降。两组的临床结局相当。
在 ACPO 患者中，使用适应性伺服通气的急救护理可降低血浆儿茶酚胺浓度，并改善呼吸困难、生命体征和酸碱平衡，而不会对临床结局产生不利影响。与单独使用标准氧气相比，使用适应性伺服通气可能会缓解呼吸困难并改善血液动力学状态，可能通过调节交感神经活动。
