摘要
目的观察并比较单纯氧疗与经鼻持续气道正压(nCPAP)通气对稳定期慢性充血性心力衰竭(CHF)患者Cheyne-Stokes呼吸的影响及疗效。方法采用前瞻、随机、交叉对照性设计。对入选患者测左室射血分数(LVEF),同时采用多导睡眠图证实是否存在Cheyne-Stokes呼吸,对存在Cheyne-Stokes呼吸者随机交叉进行整夜单纯鼻导管给氧(2L/min和4L/min)及nCPAP通气治疗[平均压力为(9·1±1·1)cmH2O]。结果共入选26例稳定期CHF患者,其中14例(53·8%)存在Cheyne-Stokes呼吸,呼吸暂停低通气指数(AHI)为(34·9±8·2)次/h,夜间最低动脉血氧饱和度(SaO2)为(76·2±4·7)%,SaO2<90%的时间占总睡眠时间百分比为(20·9±8·6)%,平均呼吸暂停低通气时间为(20·6±3·2)s,循环长度为(74·8±21·3)s,循环时间为(25·6±4·4)s。单纯鼻导管给氧(2L/min或4L/min)及nCPAP通气后,与基础状态相比,AHI降低,吸氧4L/min与nCPAP通气的效果优于吸氧2L/min;夜间最低SaO2升高;夜间SaO2<90%的时间占总睡眠时间百分比改善,以吸氧4L/min效果更佳;总睡眠时间增加,睡眠效率改善,但呼吸暂停低通气时间、循环长度及循环时间与基础状态比无明显改变。结论稳定期CHF患者Cheyne-Stokes呼吸的发生率很高,氧疗(4L/min)及nCPAP通气可作为治疗CHF患者Cheyne-Stokes呼吸的有效方法。
Objectve To compare the acute effects of oxygen therapy and nasal continuous positive airway pressure （nCPAP） therapy on Cheyne-Stokes respiration （CSR） in patients with stable chronic congestive heart failure （CHF）. Methods Prior to the study, all patients had an echocardiogram performed to measure the left ventricular ejection fraction （LVEF）. In addition, all patients had an initial sleep study to identify the presence of CSR. Those patients identified as having CSR were randomized to a night on 2 L/rain oxygen therapy, a night on 4 L/min oxygen therapy （ by nasal cannula ） and another night on nCPAP therapy [ mean pressure （9. 1 ± 1. 1 ） cm H20]. Results Twenty-six patients stable CHF, with a mean age of 64. 1±6. 8, and a mean LVEF of （27. 1 ±5.8）%, were studied, of whom 14 （53.8%） had CSR during their initial sleep study. The 14 patients had an average apnea-hypopnea index （ AHI ） of 34. 9 ± 8.2 events per hour, an average apnea-hypopnea length of （ 20. 6 ± 3.2 ） s, mean cycle length （74. 8 ±21.3）s, circulation time （25.6 ±4. 4） s, the lowest oxygen saturation during the night （76. 2 ± 4. 7）% ,the periods of time with a oxygen saturation of 〈 90% of total sleep time （20. 9 ±8.6）%. When compared with baseline measurements, both oxygen therapy （ 2 L/min or 4 L/min ） and nCPAP therapy significantly decreased the AHI, with 4 L/min oxygen therapy and nCPAP therapy producing the better results, with no significant difference between these two therapies. All three forms of treatment significantly increased the lowest oxygen saturation during the night to a similar extent. The mean percent time the oxygen saturation was 〈 90% also improved with all interventions, with 4 L/min 02 producing the best results. In addition, 2 L/min or 4 L/min oxygen therapy and nCPAP produced similar improvements in total sleep time and sleep efficiency. When compared with baseline measurements, the apnea-hypopnea length, cyclelength, and circulation time did not significantly change with either oxygen therapy or nasal CPAP therapy. Conclusion CSR occurs frequently in patients with stable CHF. Both higher concentration oxygen and nCPAP can be used as therapeutic strategies in CHF patients with CSR.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2005年第10期759-763,共5页
Chinese Journal of Internal Medicine
关键词
心力衰竭
充血性
潮式呼吸
呼吸
人工
氧吸入疗法
Heart failure, congestive
Cheyne-stokes respiration
Respiration, artificial
Oxygen therapy
