无创正压通气治疗2例慢性充血性心力衰竭合并陈-施呼吸患者经验总结及分析

目的 比较两种无创呼吸机治疗慢性充血性心力衰竭合并陈-施呼吸(cheyne-stoke respiration,CSR)患者效果.方法 选取北京市公安医院2例慢性充血性心力衰竭合并CSR患者,针对患者病情给予患者常规治疗,并在常规治疗的基础上分别采用压力支持自动伺服通气(Autoset CS)以及双水平无创正压通气(Bilevel PAP)进行治疗.比较治疗前后的呼吸频率、心率、血气变化情况(pH、PaO2、PaCO2、SaO2)、收缩压、舒张压、左室射血分数等情况.同时注意观察患者接受治疗后的不良反应,例如:局部皮肤损伤、鼻炎、明显腹胀、气压伤、误吸、低血压等.结果 采用Autoset CS治疗CSR显示出不仅有睡眠质量的提高、白天嗜睡的减轻及认知度的改善,而且心力衰竭患者的左室射血分数及心功能都有明显改善.另外采用BilevelPAP经鼻无创通气治疗CSR其参数设定吸气压通常为10.0 cm H2O;呼气压通常为6～8 cm H2O即可.吸气时间较治疗慢性阻塞性肺疾病的参数有所延长,通常为0.5～0.6 s;呼气时间较治疗慢性阻塞性肺疾病的参数有所减少,通常为0.3 S.结论 Autoset CS治疗CSR采用自动调节的伺服通气运算,提供一种全新的无创正压通气治疗形式,更及时完全地控制CSR.BilevelPAP经鼻无创通气治疗CSR其参数设定与治疗慢性阻塞性肺疾病的参数设定显著的不同.

Clinical experiences and analysis of non-invasive positive pressure ventilation in treating patients of chronic congestive heart failure with complications of Cheyne-Stoke respiration

Objective To compare the effect of two non-invasive positive pressure ventilations in treating patients of chronic congestive heart failure with complications of Cheyne-Stoke respiration(CSR). Methods Two patients of chronic congestive heart failure with complications of CSR were given conventional treatment plus adaptive-service ventilation(Autoset CS) or Bilevel PAP respectively. Parameters including respiratory rate, heart rate, pH, PaO2, PaCO2, SaO2, SBP, DBP, left ventricular ejection factor (LVEF) were measured and compared for two patients before and after treatment. Side effects including dermatitis,rhinitis, abdomen bulge, air pressure injury, mis-inhalation, and hypotension were monitored. Results Autoset CS treatment of CSR gave the patients a better sleep, alleviated sleep-addiction and improved cognition,as well as significant improvement of LVEF and cardiac function. In intranasal Bilevel PAP treatment of CSR,IP and EP were usually set to 10.0 cm H2O and 6-8 cm H2O respectively. I-slope generally took 0.5-0.6 seconds, relatively longer than chronic obstructive lung diseases, while E-slope was approximately 0.3 seconds, generally shorter than chronic obstructive lung diseases. Conclusions Autoset CS provides a novel approach in treating CSR. Different settings of parameters should be applied in treating CSR with Bilevel PAP as compared to chronic obstructive lung diseases.