Oldenburg Olaf, Spießhöfer Jens, Fox Henrik, Bitter Thomas, Horstkotte Dieter
Department of Cardiology, Heart and Diabetes Center NRW, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany,
Clin Res Cardiol. 2015 Apr;104(4):328-33. doi: 10.1007/s00392-014-0784-1. Epub 2014 Nov 6.
In patients with heart failure (HF), Cheyne-Stokes respiration (CSR) is characterized by chronic hyperventilation (HV) with low arterial partial pressure of carbon dioxide (pCO2). It is still unclear whether this HV represents a compensatory response to HF or an independent comorbidity. This study investigated the hemodynamic effects of HV in HF patients and volunteers.
A total of 15 volunteers [13 male, 25 ± 4 years, brain natriuretic peptide (BNP) <49 pg/mL, left ventricular rejection fraction (LVEF) >55 %) and 20 HF patients with reduced LVEF (15 male, 67.7 ± 12 years, NYHA class 2.6 ± 0.6, BNP 790 ± 818 pg/mL, LVEF 32.4 ± 7.3 %) were enrolled. Hemodynamics was monitored noninvasively in volunteers (TaskForce Monitor, CNSystems) and invasively in HF patients.
During HV, the transcutaneous CO2 pressure in volunteers decreased from 38.7 ± 2.5 to 28.6 ± 3.3 mmHg (p < 0.001) and pCO2 in HF patients decreased from 33.6 ± 3.7 to 22.2 ± 3.2 mmHg (p < 0.001). There was a significant increase in cardiac output (CO) in both volunteers (6.2 ± 1.3-7.5 ± 1.3 L/min, p < 0.001) and HF patients (4.4 ± 1.3-5.0 ± 1.3 L/min), mainly as a result of an increase in heart rate (67.4 ± 7.6-82.8 ± 10.9/min, p < 0.001; and 77.2 ± 17.7-86.2 ± 22.4/min, p < 0.001, respectively); stroke volume (SV) was unchanged in volunteers (93.7 ± 19.6-93.8 ± 21.4 mL) and only slightly increased in HF patients (64.4 ± 28.7-68.5 ± 23.2 mL).
CSR with associated HV may be a compensatory mechanism in patients with a failing heart. This compensatory mechanism includes an increase in heart rate, which might be deleterious in the long run.
在心力衰竭（HF）患者中，潮式呼吸（CSR）的特征为慢性通气过度（HV）伴低动脉血二氧化碳分压（pCO₂）。目前尚不清楚这种通气过度是对HF的一种代偿反应还是一种独立的合并症。本研究调查了通气过度对HF患者和志愿者的血流动力学影响。
共纳入15名志愿者[13名男性，25±4岁，脑钠肽（BNP）<49 pg/mL，左心室射血分数（LVEF）>55%]和20名LVEF降低的HF患者（15名男性，67.7±12岁，纽约心脏协会心功能分级2.6±0.6级，BNP 790±818 pg/mL，LVEF 32.4±7.3%）。对志愿者采用无创方法（TaskForce监护仪，CNSystems公司）监测血流动力学，对HF患者采用有创方法监测。
在通气过度期间，志愿者的经皮二氧化碳压力从38.7±2.5 mmHg降至28.6±3.3 mmHg（p<0.001），HF患者的pCO₂从33.6±3.7 mmHg降至22.2±3.2 mmHg（p<0.001）。志愿者（6.2±1.3 - 7.5±1.3 L/min，p<0.001）和HF患者（4.4±1.3 - 5.0±1.3 L/min）的心输出量（CO）均显著增加，主要是由于心率增加（分别为67.4±7.6 - 82.8±10.9次/分钟，p<0.001；以及77.2±17.7 - 86.2±22.4次/分钟，p<0.001）；志愿者的每搏输出量（SV）无变化（93.7±19.6 - 93.8±21.4 mL），HF患者仅略有增加（64.4±28.7 - 68.5±23.2 mL）。
伴有通气过度的潮式呼吸可能是心力衰竭患者的一种代偿机制。这种代偿机制包括心率增加，从长远来看可能是有害的。
