心不全における中枢無呼吸に対する肺毛細血管圧の影響
P Solin1, P Bergin, M Richardson
1Department of Respiratory Medicine, The Alfred Hospital, Prahran, Melbourne, Victoria, Australia.
Circulation
|March 30, 1999
まとめ
中枢睡眠時無呼吸症候群の閉塞性心不全患者は,肺毛細血管の圧 (PCWP) が高くなります. 増加したPCWPは,中央無呼吸症候群の重度と低頭症候群と相関しており,心不全と呼吸障害との関連を示唆しています.
科学分野:
- 心臓病学 心臓病学
- 肺内科 肺内科 肺内科
- スリープ・メディシン (睡眠医学)
背景:
- 急性肺詰まりは,高呼吸率,低頭症,中央睡眠時無呼吸症と関連しています.
- 慢性肺詰まりが心不全 (CHF) と中央睡眠時無呼吸症との関連性は不明である.
- この研究では,肺毛細血管の圧 (PCWP) と心筋梗塞の患者における中枢無呼吸症との関係を調査した.
研究 の 目的:
- 中枢無呼吸を患っているCHF患者のPCWPが,中枢無呼吸を患っていない患者よりも高いかどうかを判断する.
- PCWPと中央無呼吸症候群の重度の相関を評価する.
- PCWP,低頭症,および中央無呼吸症の頻度の間の関係を調査する.
主な方法:
- 安定したCHFの75人の患者は,右心臓カテーテリゼーションと夜間の睡眠研究を受けました.
- 患者は,中央無呼吸,阻害性無呼吸,または無呼吸 (無呼吸-低呼吸指数 <5) のグループに分けられました.
- 肺毛細血管の圧 (PCWP) と動脈の二酸化炭素濃度 (PaCO2) を測定し,無呼吸症候群の重度 (AHI) と相関させました.
主要な成果:
- 平均PCWPは,閉塞性アプネア (12.3 mmHg) と非閉塞性アプネア (11.5 mmHg) グループ (P<0.001) と比較して,中央無呼吸グループ (22.8 mmHg) で有意に高かった.
- 中枢無呼吸症のグループでは,PCWPは無呼吸症の重度 (AHI,r=0.47,P=0.006) と正の相関があり,PaCO2 (r=-0.42,P=0.017) と負の相関があった.
- 7人の患者の集中治療により,PCWPと中央無呼吸症の頻度が低下しました.
結論:
- 高いPCWPは,心筋梗塞の患者で中央アプネアを経験する患者の特徴です.
- PCWP,低頭症,心筋梗塞における中央睡眠時無呼吸症の頻度および重症度との間に有意な関係がある.
- これらの発見は,心不全における心機能と呼吸制御の相互作用を強調しています.
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