Andreas S, Weidel K, Hagenah G, Heindl S
Dept of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.
Eur Respir J. 1998 Aug;12(2):414-9. doi: 10.1183/09031936.98.12020414.
Cheyne-Stokes respiration (CSR) is common in patients with congestive heart failure (CHF) and is associated with significant nocturnal O2 desaturation, arousals and sympathetic activation. Nocturnal O2 reduces CSR by only about 50%. More complete suppression of CSR may be achieved by adding CO2 to O2. This study therefore aimed to evaluate the effects of nocturnal O2 plus CO2 on CSR, sleep and sympathetic activation. Nine patients with CHF (age 59+/-5 yrs; left ventricular ejection fraction 17.8+/-1.2% (mean+/-SEM) were studied in a cross-over, single-blind, placebo-controlled trial. After an accommodation night the patients were randomly assigned to one night each of O2 plus CO2 as well as air applied by nasal prongs. Nocturnal O2 plus CO2 reduced the duration of CSR as percentage of total sleep time (48.0+/-10 versus 7.4+/-2.0%; p=0.008) and increased arterial oxygen saturation (Sa,O2) as well as mean transcutaneous carbon dioxide tension (Ptc,CO2) (5.2+/-0.3 kPa (39+/-2 mmHg) versus 5.7+/-0.3 kPa (43+/-2 mmHg) p=0.011). Sleep did not improve and arousals were not reduced. Plasma noradrenaline was higher on the treatment night (486+/-116 versus 669+/-163 ng x L(-1); p=0.035). In conclusion, nocturnal O2 plus CO2 improves Cheyne-Stokes respiration in patients with congestive heart failure but has adverse effects on the sequel of Cheyne-Stokes respiration, namely sympathetic activation.
潮式呼吸（CSR）在充血性心力衰竭（CHF）患者中很常见，且与显著的夜间氧饱和度下降、觉醒和交感神经激活有关。夜间吸氧仅能使潮式呼吸减少约50%。通过在氧气中添加二氧化碳可能会更有效地抑制潮式呼吸。因此，本研究旨在评估夜间吸氧加二氧化碳对潮式呼吸、睡眠和交感神经激活的影响。在一项交叉、单盲、安慰剂对照试验中，对9例CHF患者（年龄59±5岁；左心室射血分数17.8±1.2%（平均值±标准误））进行了研究。经过一个适应夜后，患者被随机分配，分别接受一晚的吸氧加二氧化碳以及经鼻导管给予空气。夜间吸氧加二氧化碳可使潮式呼吸持续时间占总睡眠时间的百分比降低（48.0±10%对7.4±2.0%；p = 0.008），并提高动脉血氧饱和度（Sa,O2）以及平均经皮二氧化碳分压（Ptc,CO2）（5.2±0.3 kPa（39±2 mmHg）对5.7±0.3 kPa（43±2 mmHg），p = 0.011）。睡眠并未改善，觉醒也未减少。治疗当晚血浆去甲肾上腺素水平更高（486±116对669±163 ng x L(-1)；p = 0.035）。总之，夜间吸氧加二氧化碳可改善充血性心力衰竭患者的潮式呼吸，但对潮式呼吸的后续影响即交感神经激活有不良作用。
