Haarmann Helge, Folle Jan, Nguyen Xuan Phuc, Herrmann Peter, Heusser Karsten, Hasenfuß Gerd, Andreas Stefan, Raupach Tobias
Clinic for Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany.
Mannheim Biomedical Engineering Laboratories, Medical Faculty at Heidelberg University, Mannheim, Germany.
Lung. 2017 Feb;195(1):69-75. doi: 10.1007/s00408-016-9965-1. Epub 2016 Nov 16.
Chronic obstructive pulmonary disease (COPD) is associated with elevated sympathetic nerve activity, which is probably linked to an increased cardiovascular risk, and may contribute to muscle dysfunction by heightened muscle vasoconstrictor drive. We hypothesized that resistive unloading of respiratory muscles by intermittent non-invasive ventilation (NIV) reduces sympathetic tone at rest and during subsequent handgrip exercise in patients with COPD.
Muscle sympathetic nerve activity (MSNA) in the peroneal nerve, heart rate, blood pressure, CO, and SpO were continuously recorded in 5 COPD patients with intermittent NIV and 11 control COPD patients without NIV. Static and dynamic handgrip exercises were performed before and after NIV.
At baseline, heart rate-adjusted MSNA (bursts/100 heart beats) did not differ between groups. NIV did not significantly affect MSNA levels at rest. However, during handgrip exercises directly following NIV, MSNA was lower than before, which was significant for dynamic handgrip (67.00 ± 3.70 vs. 62.13 ± 4.50 bursts/100 heart beats; p = 0.035 in paired t test). In contrast, MSNA (non-significantly) increased in the control group during repeated dynamic or static handgrip. During dynamic handgrip, tCO was lower after NIV than before (change by -5.04 ± 0.68 mmHg vs. -0.53 ± 0.64 in the control group; p = 0.021), while systolic and diastolic blood pressure did not change significantly.
NIV reduces sympathetic activation during subsequent dynamic handgrip exercise and thereby may elicit positive effects on the cardiovascular system as well as on muscle function in patients with COPD.
慢性阻塞性肺疾病（COPD）与交感神经活动增强有关，这可能与心血管风险增加有关，并且可能通过增强肌肉血管收缩驱动力导致肌肉功能障碍。我们假设，通过间歇性无创通气（NIV）对呼吸肌进行阻力卸载可降低COPD患者静息时以及随后进行握力运动时的交感神经张力。
连续记录5例接受间歇性NIV的COPD患者和11例未接受NIV的对照COPD患者的腓总神经肌肉交感神经活动（MSNA）、心率、血压、心输出量（CO）和血氧饱和度（SpO）。在NIV前后进行静态和动态握力运动。
基线时，两组间心率校正后的MSNA（爆发次数/100次心跳）无差异。NIV对静息时的MSNA水平无显著影响。然而，在NIV后的握力运动期间，MSNA低于之前，动态握力时差异显著（67.00±3.70对62.13±4.50爆发次数/100次心跳；配对t检验中p = 0.035）。相比之下，对照组在重复动态或静态握力过程中MSNA（无显著差异）增加。动态握力时，NIV后心输出量（tCO）低于之前（变化为-5.04±0.68 mmHg，对照组为-0.53±0.64；p = 0.021），而收缩压和舒张压无显著变化。
NIV可降低随后动态握力运动期间的交感神经激活，从而可能对COPD患者的心血管系统以及肌肉功能产生积极影响。
