无创正压通气对慢性充血性心力衰竭合并潮式呼吸-中枢性睡眠呼吸暂停的影响

摘要

Objective:To investigate the effect of noninvasive positive pressure ventilation on pa-tients with chronic congestive heart failure combined with cheyne-stokes respiration and central sleep apnea .Methods:67 patients with CHF combined with CSR-CSA were divided into NPPV group(34 cases) and control group (33 cases) according to the different therapeutic regimens . The NPPV group was treated with standard medications and NPPV , and the control group was trea-ted with standard medications.Results:①NPPV group’s BMI, ESS score, AHI, arousal index after treatment were lower than before treatment ( P<0.05 ) , lowest oxygen saturation ( L-SaO 2) were increased in Ⅲperiod and not rapid eye movement ( NREM) ( P<0.05) .②NYHA, BNP of NPPV group was reduced and lower than before treatment ( P<0.05 ) , LVEF was higher ( P<0 .05 ) , the difference was statistically significant .Conclusion: For patients with CHF combined with CSR-CSA, NPPV could improve the heart function and deserve the clinical expansion .%目的：探讨无创正压通气（ noninvasive positive pressure ventilation ，NPPV）治疗对慢性充血性心力衰竭（chronic heart failure，CHF）合并潮式呼吸（cheyne-stokes respiration，CSR）-中枢性睡眠呼吸暂停（central sleep apnea，CSA）患者的影响。方法：回顾性分析67例CHF合并CSR-CSA患者，根据治疗方案不同分为NPPV组（34例）和对照组（33例），对照组单纯行常规抗心衰药物治疗，NPPV组在常规抗心衰药物治疗基础上加用NPPV，治疗6个月复查。结果：①NPPV组治疗前后比较，BMI、ESS评分、呼吸暂停低通气指数（ AHI）、微觉醒指数均明显下降（P＜0．05）；Ⅲ期及快速动眼期睡眠时间、最低血氧饱和度（L-SaO2）明显增加（P＜0．05）。②治疗后，NPPV组纽约心功能分级（ NYHA）、B 型脑钠肽（ BNP）均较前降低，左心室射血分数（LVEF）、6 min步行距离较前增加，差异有统计学意义（P＜0．05）。结论：对CHF合并CSR-CSA患者，在常规应用抗心衰药物治疗基础上积极采用NPPV治疗，可更大程度地改善心脏功能，值得临床推广应用。