适应性支持通气治疗慢性心力衰竭合并睡眠呼吸障碍疾病的疗效及对心功能的影响

Efficacy of ASV in treatment of CHF complicated with SDB and its effect on cardiac function

目的探讨适应性支持通气(Adaptive support ventilation,ASV)治疗慢性心力衰竭(Chronic heart failure,CHF)合并睡眠呼吸障碍疾病(Sleep disordered breathing,SBD)的效果及对患者心功能的影响。方法选取我院收治的100例CHF合并睡眠呼吸暂停低通气综合征的患者(收治时间2015年1月-2016年12月),采用随机数字表法分为A组、B组各50例,两组基础治疗一致,A组采用ASV法治疗,B组采用双水平呼吸道正压通气治疗,对比两组的治疗效果。结果治疗前,两组患者的左心室舒张末期内径(Left ventricular end diastolic,LVEDd)、左心室射血分数(Left ventricular ejection fraction,LVEF)、左室收缩末期内径(Left ventricular end systolic diameter,LVESd)差异无统计学意义(P>0.05);治疗后,A组患者的LVEDd、LVESd显著的低于B组(P<0.05)、LVEF显著的高于B组(P<0.05);治疗前,两组患者的氨基末端B型脑钠肽前体(N-terminal type B brain natriuretic peptide,NT-pro BNP)、睡眠呼吸暂停低通气指数(Apnea hypopnea index,AHI)、内皮素(Endothelin,ET)、一氧化氮(Nitric oxide,NO)、最长低通气时间、夜间血氧饱和度(Oxygen saturation of blood,Sa O2)差异无统计学意义(P>0.05);治疗后,A组患者的NT-pro BNP、ET、AHI、最长低通气时间显著的低于B组(P<0.05)、NO、夜间Sa O2显著的高于B组(P<0.05);A组患者的不良反应发生率6.00%低于B组的20.00%,差异具有统计学意义(χ2=4.333,P=0.037<0.05)。结论 ASV治疗CHF合并SBD患者的效果更加显著,不良反应发生率更低。

Objective To investigate the effect of adaptive support ventilation(ASV)on chronic heart failure(CHF)complicated with sleep disordered breathing(SDB)and its effect on cardiac function.Methods 100 CHF patients complicated with SDB from January 2015 to December 2016 were randomly divided into the A group and the B group.The group A was treated with ASV therapy,and the group B were treated with BiPAP ventilation therapy.The treatment effects were compared between the two groups.Results There was no significant difference in LVEDd,LVEF and LVESd between the two groups before treatment(P>0.05).After treatment,the value of LVEDd and LVESd in the group A were significantly lower than those in the group B(P<0.05).Before treatment,there was no significant differences in NT-proBNP,ET,NO,AHI,longest and low ventilation time and nocturnal SaO2 between the two groups(P>0.05).After treatment,NO and nocturnal SaO2 were significantly higher in the group A than in the group B(P<0.05).The incidence of adverse events in the group A(6%)was significantly lower than that in the group B(20%)(χ2=4.333,P=0.037<0.05).Conclusion ASV has significant effect in treatment of CHF patients complicated with SBD,with low incidence of adverse reactions.