Martínez A, Muñoz V, Lisboa C, Jalil J, Godoy I, Moreno R, Ferretti R, Casanegra P, Saldías F, Guarda E
Departamento de Enfermedades Cardiovasculares, Universidad Católica de Chile, Santiago.
Rev Med Chil. 1995 Dec;123(12):1467-75.
The higher respiratory work and less inspiratory muscle strength of patients with cardiac failure may contribute to decrease their functional capacity.
To assess the effects of non invasive intermittent mechanical ventilation on clinical parameters, peripheral perfusion, cardiac and inspiratory muscle function.
Patients with chronic cardiac failure, functional capacity III-IV were subjected to 6 sessions of nasal non invasive intermittent ventilation during 4 hours or to simulated ventilation (controls).
Fifteen ventilated patients and six controls completed the protocol. Ventilated patients improved the Mahler transition score for dyspnea by 4 +/- 1.6 points. They also improved their aerobic capacity, increasing the exercise duration from 10.9 +/- 4 to 12.7 +/- 5 min and their maximal oxygen consumption from 14.6 +/- 4 to 16.4 +/- 5.7 ml/kg/min. These patients also decreased their O2 and CO2 ventilatory equivalents. Maximal inspiratory pressure increased from 67.9 +/- 23.6 to 80.19 +/- 21.4 cm H2O, sustained maximal inspiratory pressure increased from 101.4 +/- 48 to 133 +/- 53 cm H2O and maximal endurance increased from 132 +/- 52 to 162 +/- 58 g in ventilated patients. None of these variables was modified in control patients. No changes were observed in renal function, blood volume, arterial gases, spirometry or plasma catecholamine levels in any group.
Intermittent nasal ventilation or other measures to improve inspiratory muscle function may be beneficial for patients with severe cardiac failure.
心力衰竭患者较高的呼吸功和较弱的吸气肌力量可能导致其功能能力下降。
评估无创间歇性机械通气对临床参数、外周灌注、心脏及吸气肌功能的影响。
功能能力为Ⅲ - Ⅳ级的慢性心力衰竭患者接受4小时的6次经鼻无创间歇性通气治疗或模拟通气治疗（对照组）。
15例接受通气治疗的患者和6例对照组患者完成了该方案。接受通气治疗的患者的马勒呼吸困难过渡评分提高了4±1.6分。他们的有氧运动能力也有所改善，运动持续时间从10.9±4分钟增加到12.7±5分钟，最大耗氧量从14.6±4毫升/千克/分钟增加到16.4±5.7毫升/千克/分钟。这些患者的氧通气当量和二氧化碳通气当量也有所降低。接受通气治疗的患者的最大吸气压力从67.9±23.6厘米水柱增加到80.19±21.4厘米水柱，持续最大吸气压力从101.4±48厘米水柱增加到133±53厘米水柱，最大耐力从132±52克增加到162±58克。对照组患者的这些变量均未改变。任何一组的肾功能、血容量、动脉血气、肺量计或血浆儿茶酚胺水平均未观察到变化。
间歇性经鼻通气或其他改善吸气肌功能的措施可能对重度心力衰竭患者有益。
