Feld H, Priest S
Maimonides Medical Center, Division of Cardiology, Brooklyn, New York 11219.
J Am Coll Cardiol. 1993 Mar 15;21(4):971-4. doi: 10.1016/0735-1097(93)90355-5.
This study was designed to evaluate the breathing patterns of patients with poor left ventricular systolic function and compensated heart failure.
Cheyne-Stokes respiration is often found in patients with severe decompensated heart failure. Breathing patterns of patients with clinically moderate congestive heart failure have not been well described.
Tidal volume, oxygen consumption, carbon dioxide production, respiratory rate, minute ventilation and partial pressure of end-tidal oxygen and of end-tidal carbon dioxide were measured in 36 consecutive patients with an ejection fraction < 40% and compensated congestive heart failure. Measurements were made with a computerized expiratory gas analyzer.
Nine of the 36 patients demonstrated a cyclic breathing pattern, with a cycle length of 130 +/- 82 s. At the peak of the cycle, minute ventilation was 16.7 +/- 2.9 liters/min, tidal volume was 582 +/- 130 ml, end-tidal carbon dioxide was 25 +/- 2.7 mm Hg and end-tidal oxygen was 121 +/- 4.9 mm Hg. At the nadir of the cycle, minute ventilation was 9.5 +/- 2.1 liters/min, tidal volume was 372 +/- 120 ml, end-tidal carbon dioxide was 35 mm Hg +/- 2.1 and end-tidal oxygen was 101 +/- 3.9 mm Hg. Respiratory rate was 27 +/- 5.9 breaths/min at peak and 24 +/- 5.1 breaths/min at nadir (p = NS). Patients with a cyclic respiratory pattern had a significantly lower ejection fraction (15 +/- 5%) compared with patients without cyclic respirations (26 +/- 8%; p < 0.001). There was no difference in the origin of heart failure, clinical status or exercise performance between these two groups.
A cyclic respiratory pattern occurs commonly in patients with mild to moderate heart failure. It is related to poor left ventricular systolic function and not related to clinical status or etiology of heart failure. The cyclic respiratory pattern found commonly in patients with compensated heart failure and very poor ventricular function (ejection fraction < 25%) consists of a variation in tidal volume only. Respiratory rate is relatively constant and true apnea does not occur.
本研究旨在评估左心室收缩功能不佳且心力衰竭已代偿患者的呼吸模式。
潮式呼吸在严重失代偿性心力衰竭患者中较为常见。临床中度充血性心力衰竭患者的呼吸模式尚未得到充分描述。
对36例连续入选的射血分数<40%且充血性心力衰竭已代偿的患者，测量其潮气量、氧耗量、二氧化碳生成量、呼吸频率、分钟通气量以及呼气末氧分压和呼气末二氧化碳分压。测量使用计算机化呼气气体分析仪进行。
36例患者中有9例表现出周期性呼吸模式，周期长度为130±82秒。在周期峰值时，分钟通气量为16.7±2.9升/分钟，潮气量为582±130毫升，呼气末二氧化碳为25±2.7毫米汞柱，呼气末氧为121±4.9毫米汞柱。在周期最低点时，分钟通气量为9.5±2.1升/分钟，潮气量为372±120毫升，呼气末二氧化碳为35±2.1毫米汞柱，呼气末氧为101±3.9毫米汞柱。呼吸频率在峰值时为27±5.9次/分钟，在最低点时为24±5.1次/分钟（p=无显著差异）。有周期性呼吸模式的患者与无周期性呼吸的患者相比，射血分数显著更低（15±5%对26±8%；p<0.001）。这两组患者在心力衰竭的起源、临床状态或运动表现方面无差异。
周期性呼吸模式在轻度至中度心力衰竭患者中常见。它与左心室收缩功能不佳有关，而与心力衰竭的临床状态或病因无关。在心力衰竭已代偿且心室功能极差（射血分数<25%）的患者中常见的周期性呼吸模式仅由潮气量变化组成。呼吸频率相对恒定，且不会出现真正的呼吸暂停。
