慢性心力衰竭中周期性呼吸的定量一般理论及其临床影响
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
概括
慢性心力衰竭的周期性呼吸是由评估心肺呼吸稳定的新公式预测的. 化学反射增强和延迟,而不是高通风,导致这种不稳定.
科学领域:
- 心血管呼吸系统生理学
- 临床诊断 临床诊断 临床诊断
- 心力衰竭研究研究
背景情况:
- 定期呼吸 (PB),包括切恩-斯托克斯呼吸,是慢性心力衰竭 (CHF) 的常见并发症,也是不良预后的预测因素.
- 关于PB机制的现有理论,通常基于延迟负反的计算机模拟,缺乏使用临床概念的简单,定量解释.
- 需要一种新的方法来定量分析CHF患者的不稳定性背后的心肺呼吸系统动态.
研究的目的:
- 开发一种新的定量方法来分析心肺衰竭患者的心肺稳定性.
- 通过使用易于获得的临床数据,推导出用于识别不稳定的呼吸模式的预测公式.
- 阐明驱动CHF周期性呼吸的特定生理机制.
主要方法:
- 开发了一种代数公式来预测心肺稳定性,可视化为2D图.
- 在30名受试者中验证了配方:20名患有心血管衰竭 (10名患有PB,10名没有) 和10名健康对照.
- 测量化学反射灵敏度 (S),延迟 (delta),气泡体积 (V) 和最终潮CO2分数 (C) 应用于稳定性公式.
主要成果:
- 稳定公式在30名受试者中正确预测了28名受试者的呼吸模式.
- 一个关键参数, (CS) x ((delta/V ((L))),与没有PB (3.1±0.5) 和健康对照 (2.4±0.5) 的患者相比,患有PB (14.2±3.0) 的CHF患者显着更高.
- 在PB患者中观察到高化学反射灵敏度 (1749±235 L/分钟每大气CO2) 和长时间化学反射延迟 (0.53±0.06分钟).
结论:
- 开发的分析方法成功地识别了导致CHF中PB起源的关键生理异常.
- 该研究明确定义了基于定量生理参数的预测不稳定区域.
- 化学反射增益和延迟时间被确定为CHF中PB的主要原因,而不是高通风或低头症.
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