Yajima T, Koike A, Sugimoto K, Miyahara Y, Marumo F, Hiroe M
Hokushin General Hospital, Tokyo, Japan.
Chest. 1994 Jul;106(1):142-6. doi: 10.1378/chest.106.1.142.
Although periodic breathing consisting of alternating hyperpnea and hypopnea has been recognized in heart failure patients, its mechanism has not been clarified. We hypothesized that heart failure patients who have oscillations in ventilation will also be found to have oscillations in pulmonary blood flow, as reflected in left ventricular ejection fraction. To test this hypothesis, we analyzed continuously gas exchange and left ventricular ejection fraction during exercise in cardiac patients who exhibited periodic breathing. Out of 48 consecutive patients with reduced left ventricular function who performed a symptom-limited incremental exercise test using an upright cycle ergometer, we selected 5 patients who exhibited clear ventilatory oscillations during exercise. These patients repeated the same exercise test on another day for measuring gas exchange and left ventricular ejection fraction continuously. Oscillatory changes were noted both in left ventricular ejection fraction and in ventilation in these patients. These observations offer support for the hypothesis that fluctuations in pulmonary blood flow are primarily responsible for the periodic breathing seen in heart failure patients.
尽管心力衰竭患者中存在由交替性呼吸增强和呼吸减弱组成的周期性呼吸已得到认可，但其机制尚未阐明。我们推测，通气有振荡的心力衰竭患者也会出现肺血流振荡，这在左心室射血分数中有所体现。为了验证这一假设，我们对表现出周期性呼吸的心脏病患者运动期间的气体交换和左心室射血分数进行了连续分析。在48例连续的左心室功能减退患者中，他们使用直立式自行车测力计进行了症状限制递增运动试验，我们选择了5例在运动期间表现出明显通气振荡的患者。这些患者在另一天重复相同的运动试验，以连续测量气体交换和左心室射血分数。在这些患者中，左心室射血分数和通气均出现了振荡变化。这些观察结果支持了以下假设，即肺血流波动是心力衰竭患者出现周期性呼吸的主要原因。
