三种气道正压通气对心力衰竭患者陈-施氏呼吸的疗效比较

Comparison of the Effects of Three Kinds of Positive Airway Pressure Treatment for Cheyne-Stokes Respiration in Patients with Chronic Heart Failure

目的:比较持续气道正压通气(CPAP),双水平正压通气(BiPAP)与匹配伺服通气(ASV)对慢性心力衰竭(CHF)患者陈-施氏呼吸(CSR)的疗效区别。方法:选择存在睡眠期CSR的稳定期CHF患者14例,比较治疗前和分别经CPAP,BiPAP和ASV治疗时睡眠呼吸及睡眠结构和质量相关参数。结果:与治疗前相比,三种气道正压通气治疗时睡眠呼吸暂停低通气指数(AHI)和微觉醒指数(MAI)明显降低(P<0.01),而最低脉氧饱和度(miniSpO2)显著升高(P<0.01);睡眠结构参数Ⅰ+Ⅱ期睡眠比率显著降低(P<0.01),而慢波睡眠比率显著增高(P<0.01)。三种治疗中AHI,MAI和Ⅰ+Ⅱ期睡眠比率ASV治疗时最低,CPAP治疗时最高,且不同治疗期间比较均有统计学差异(P<0.05);miniSpO2和慢波睡眠比率ASV治疗时最高,CPAP治疗时最低。结论:CPAP、Bi-PAP与ASV治疗均可改善CHF患者CSR的AHI和MAI,并且可改善睡眠结构,但以ASV治疗的疗效最为显著。

Objective： To compare the efficacies for Cheyne-Stokes respiration in patients with chronic heart failure （CHF） by CPAP, BiPAP and adaptive servo-ventilation （ASV） treatments. Methods： Fourteen patients with CHF and CSR were recruited. Comparisons before and after CPAP, BiPAP and ASV treatments were made for the parameters of sleep respiration, sleep structure and quality. Results： Compared with the baseline levels of apnea hypopnoea index （AHI）, microarousal （MAI） and minimal pulse oxygen saturation （miniSpO2）before treatment, those of AHI and MAI were significantly decreased but that of miniSpO2 significantly increased after three kinds of treatment （all P〈0.01）. Compared with the baseline sleep structure parameters, the percentages of Stages Ⅰ＋Ⅱ sleep/ total sleep time （TST） was significantly decreased, but that of slow wave sleep/TST significantly increases after three kinds of treatment （all P〈0.01）. Comparison among three treatments showed that a） AHI, MAI and Stages Ⅰ＋Ⅱ sleep/TST was the lowest in ASV treatment but highest in CPAP treatment with a statistical difference among three treatments （all P〈0.05）; b） miniSpO2 and slow wave sleep/TST was the highest in ASV treatment but lowest in CPAP treatment. Conclusion AHI, MAI, miniSpO2, sleep structure and quality could be all significantly improved in CHF patients with CSR by CPAP or BiPAP or ASV treatments. ASV demonstrated as the most effective therapy among the three treatments.