心源性运动呼吸异常：心衰患者运动期间波浪式呼吸的临床观察

Circulatory breathing abnormality:Clinical observation on exercise induced oscillatory breathing pattern

目的:探讨心力衰竭患者在运动期间诱发的异常波浪式呼吸模式(EIOB)的临床特点及发生机制。方法:回顾分析38例NYHAⅢ-Ⅳ级患者完成的症状限制性功率递增极限心肺运动试验(CPET)。观察分析计算心力衰竭患者在CPET中EIOB的发生时间、频率、振幅等临床特点。结果:本组患者男17女21在38例患者中,31例发生EIOB,发生率为81.6%。EIOB组每分通气量(V4E)波浪振幅是(12±4)L/m(为平均值的81%±30%),周期(77.0±20.0)s。EIOB组中OB发生在运动前、运动中功率低于无氧阈时、恢复期或者全程分别为24、31、4和4例;除V4E外,在CPET的各项参数中,全部31例患者均表现EIOB的指标为V4O2、V4CO2、RER和PETO2;29例患者V4E/V4 CO2、V4O2/V4E和BF出现EIOB;26例患者PETCO2出现EIOB;25例患者VT、V4O2/HR出现EIOB;2例患者HR出现EIOB。结论:严重心力衰竭患者易发生EIOB。就心脏功能对呼吸调控的影响及心衰患者呼吸异常发生机制进行了探讨。

Objective： Exercise induced oscillatory ventilation （EIOB） during cardiopulmonary exercise testing （CPET） is associated with severity and prognosis of disease, but clinical approach for the character of EIOB due to circulatory dysfunction are seldom reported. Methods： This retrospective analysis of symptom-limited maximum CPET data with an increment of 10-20 W/min in 38 patients with CHE We calculated the duration, frequency, amplitude and other parameters of EIOB. Results： There were 31 presenting with EIOB （82%） in all patients with CHE In EIOB group, VE amplitude were （12.4±4.4）L/min （accounting for 81%±30% of mean） and duration were （77.0＋20.0）s. The number of patients whose EIOB presenting at rest, exercise, recovery stage and the whole period were 24, 31, 4 and 4, respectively. Except VE, there were VO, VCO2, RER and PETO2 presenting EIOB in all 31 patients; VE/ VCO2, VO2/ VE and breath frequency in 29 patients ; PETCO2 in 26 patients; VT and VOJHR in 25 patients ; and HR in 2 patients. Conclusion： EIOB may occur in any period of CPET, mostly in severe patient with CHF, and presenting in many variables. Due to it is resulted from the circulatory dysfunction, we should call it circulatory （cardiac） oscillatory breathing abnormality.