慢性心不全における定期呼吸に関する定量的な一般理論とその臨床的影響
D P Francis1, K Willson, L C Davies
1Royal Brompton Hospital, National Heart and Lung Institute, London, UK.d.francis@cheerful.com
Circulation
|November 1, 2000
まとめ
慢性心不全における定期的な呼吸は,心呼吸器の安定性を評価する新しい式によって予測されています. 高呼吸ではなく,化学反射の増強と遅延が,この不安定性を引き起こします.
科学分野:
- 心臓呼吸器の生理学について
- クリニカル診断とは
- 心不全の研究について
背景:
- チェイン・ストークス呼吸を含む定期呼吸 (PB) は,慢性心不全 (CHF) の一般的な合併症であり,予後不良の予測因子です.
- PBメカニズムに関する既存の理論は,しばしば遅延ネガティブなフィードバックのコンピュータシミュレーションに基づいているが,臨床的概念を用いた単純な定量的な説明がない.
- CHF患者における不安定性の根底にある心呼吸器の動態を定量的に分析するには,新しいアプローチが必要です.
研究 の 目的:
- CHFの患者における心呼吸器の安定性を分析するための新しい定量的な方法を開発する.
- 容易に入手可能な臨床データを用いて,不安定な呼吸パターンを特定するための予測式を導き出す.
- CHFにおける周期的な呼吸を駆動する特定の生理学的メカニズムを解明する.
主な方法:
- 2Dプロットとして可視化された心呼吸器の安定性を予測するための代数式を開発しました.
- 公式を30人の被験者に検証した:20人のCHF (10人のPB,10人の無) と10人の健康な対照群.
- 測定された化学反射感度 (S),遅延 (デルタ),膜体積 (V{\ L}),および終潮CO{\ 2}分数 (C) を安定性式に適用する.
主要な成果:
- 安定化式は30人の被験者のうち28人の呼吸パターンを正しく予測した.
- 重要なパラメータである (CS) x (((デルタ/V ((L)) は,PB (14.2±3.0) を有するCHF患者において,PB (3.1±0.5) を有しない患者および健康な対照群 (2.4±0.5) と比較して,著しく高かった.
- 化学反射感度の上昇 (1749±235 L/min per atm CO(2) と長時間の化学反射遅延 (0.53±0.06 min) は,PB患者で観察されました.
結論:
- 開発された分析的アプローチは,CHFにおけるPBの発生に貢献する重要な生理学的異常を成功裏に特定しています.
- この研究は,定量的生理学的パラメータに基づいて予測された不安定性の領域を明示的に定義しています.
- 化学反射の増強と遅延時間は,高呼吸量または低頭症ではなく,CHFにおけるPBの主な原因として特定されています.
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