ASV在重度心衰合并陈-施呼吸患者中的应用
The aplication of Adaptive servo-ventilation(ASV) in sever heart failure patients with Cheyne-Stokes respiration

李旺春,张晓斌,陆瑞珍,厉伟明.ASV在重度心衰合并陈-施呼吸患者中的应用[J].内科急危重症杂志,2016,22(6):

DOI：

英文关键词:Mechanic ventilation Sleep-disordered breathing Cheyne-Stokes respiration Heart failure

基金项目:

作者	单位	E-mail
李旺春	佛山市顺德区桂洲医院	FZZZ1980@sina.com
张晓斌	佛山市顺德区桂洲医院
陆瑞珍	佛山市顺德区桂洲医院
厉伟明	东阳市人民医院

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中文摘要:

目的探讨匹配压力支持伺服通气(Adaptive servo-ventilation,ASV)治疗重度心力衰竭的疗效与安全性。方法选取重度心力衰竭合并陈-施呼吸(Cheyne-Stokes respiration,CSR)患者40例。随机分为ASV组(n=20)和持续气道正压通气(Continuous positive airway pressure, CPAP)组(n=20),治疗4周后比较两种疗法治疗前后的心功能相关指标、睡眠呼吸及睡眠结构和质量相关参数及并发症发生情况。结果治疗后,ASV组和CPAP组的左心室射血分数(LVEF)和6min 步行距离均显著高于治疗前(P均<0.05)；且两组pro-BNP水平均显著低于治疗前(P均<0.05)；两组pro-BNP和6min步行试验改善情况,ASV组明显高于CPAP组(P均<0.05)。ASV能明显改善呼吸暂停低通气指数(apnea hypopnea index,AHI)、最低脉氧饱和度、微觉醒指数、I II期睡眠比率、Ⅲ Ⅳ期睡眠比率、快动眼睡眠比率及睡眠效率(P均<0.05),而CPAP只明显改善AHI和最低脉氧饱和度(P<0.05),且改善程度明显低于ASV组(P<0.05)。ASV组气胸发生率显著低于CPAP组(P<0.05)。结论 ASV可明显改善伴CSR的重症心衰患者的心功能和睡眠呼吸紊乱,且不增加并发症的发生率。

英文摘要:

Objective To investigate the efficacy and safety ofSadaptive servo-ventilation (ASV) in patients with severe heart failure. Methods A total of 40 patients suffering from severe heart failure (HF) with Cheyne-Stokes respiration (CSR) were divided into ASV group (n=20) and continual positive airway pressure (CPAP)Sgroup (n=20) randomly. After 4 weeks’ ventilation, cardiac function indexes, results of polysomnography and complications before and after therapy were compared and analyzed. Results In both ASV and CPAP groups, the left ventricle ejection fraction (LVEF) and 6-min walk distance after treatment were obviously higher than that before treatment (P<0.05), and pro-BNP obviously lower than that before treatment (P<0.05), and the improving extent of pro-BNP and 6-min walk distance of ASV were significantly higher than that of CPAP group (P<0.05). ASV could obviously improve the apnea hypopnea index (AHI), the minimal pulse oxygen saturation, arousal index, the percentage of I Ⅱstage sleep time, Ⅲ Ⅳstage sleep time, fast movement sleep time and sleeping efficiency (P<0.05), while CPAP could only improve AHI and the minimal pulse oxygen saturation (P<0.05), and its improving extent were obviously lower than that of CPAP group. The incidence of pneumothorax in ASV group was significantly lower than than in CPAP group (P<0.05). Conclusion ASV can obviously improve the heart function and sleep disordered-breathing in sever heart failure patients with CSR, while do not increase the incidence of pneumothorax