Haque W A, Boehmer J, Clemson B S, Leuenberger U A, Silber D H, Sinoway L I
Division of Cardiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA.
J Am Coll Cardiol. 1996 Feb;27(2):353-7. doi: 10.1016/0735-1097(95)00474-2.
This study sought to determine the hemodynamic effects of oxygen therapy in heart failure.
High dose oxygen has detrimental hemodynamic effects in normal subjects, yet oxygen is a common therapy for heart failure. Whether oxygen alters hemodynamic variables in heart failure is unknown.
We studied 10 patients with New York Heart Association functional class III and IV congestive heart failure who inhaled room air and 100% oxygen for 20 min. Variables measured included cardiac output, stroke volume, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance, mean arterial pressure and heart rate. Graded oxygen concentrations were also studied (room air, 24%, 40% and 100% oxygen, respectively; n = 7). In five separate patients, muscle sympathetic nerve activity and ventilation were measured during 100% oxygen.
The 100% oxygen reduced cardiac output (from 3.7 +/- 0.3 to 3.1 +/- 0.4 liters/min [mean +/- SE], p < 0.01) and stroke volume (from 46 +/- 4 to 38 +/- 5 ml/beat per min, p < 0.01) and increased pulmonary capillary wedge pressure (from 25 +/- 2 to 29 +/- 3 mm Hg, p < 0.05) and systemic vascular resistance (from 1,628 +/- 154 to 2,203 +/- 199 dynes.s/cm5, p < 0.01). Graded oxygen led to a progressive decline in cardiac output (one-way analysis of variance, p < 0.0001) and stroke volume (p < 0.017) and an increase in systemic vascular resistance (p < 0.005). The 100% oxygen did not alter sympathetic activity or ventilation.
In heart failure, oxygen has a detrimental effect on cardiac output, stroke volume, pulmonary capillary wedge pressure and systemic vascular resistance. These changes are independent of sympathetic activity and ventilation.
本研究旨在确定氧疗对心力衰竭患者的血流动力学影响。
高剂量氧气对正常受试者有不利的血流动力学影响，但氧气是心力衰竭的常用治疗方法。氧气是否会改变心力衰竭患者的血流动力学变量尚不清楚。
我们研究了10例纽约心脏协会功能分级为III级和IV级的充血性心力衰竭患者，他们分别吸入室内空气和100%氧气20分钟。测量的变量包括心输出量、每搏输出量、肺毛细血管楔压、体循环和肺循环血管阻力、平均动脉压和心率。还研究了分级氧浓度（分别为室内空气、24%、40%和100%氧气；n = 7）。在另外5例患者中，在吸入100%氧气期间测量肌肉交感神经活动和通气。
吸入100%氧气可降低心输出量（从3.7±0.3降至3.1±0.4升/分钟[平均值±标准误]，p < 0.01）和每搏输出量（从46±4降至38±5毫升/次搏动，p < 0.01），并增加肺毛细血管楔压（从25±2升至29±3毫米汞柱，p < 0.05）和体循环血管阻力（从1628±154升至2203±199达因·秒/厘米⁵，p < 0.01）。分级氧浓度导致心输出量（方差分析，p < 0.0001）和每搏输出量（p < 0.017）逐渐下降，体循环血管阻力增加（p < 0.005）。100%氧气未改变交感神经活动或通气。
在心力衰竭患者中，氧气对心输出量、每搏输出量、肺毛细血管楔压和体循环血管阻力有不利影响。这些变化与交感神经活动和通气无关。
