Việc sử dụng ngắn hạn thông khí servo thích ứng cải thiện chức năng thận ở bệnh nhân suy tim có rối loạn hô hấp trong khi ngủ

Springer Science and Business Media LLC - Tập 28 - Trang 728-734 - 2012
Akiomi Yoshihisa1,2, Satoshi Suzuki1,2, Takashi Owada2, Shoji Iwaya2, Hiroyuki Yamauchi2, Makiko Miyata2, Takayoshi Yamaki2, Koichi Sugimoto2, Hiroyuki Kunii2, Kazuhiko Nakazato2, Hitoshi Suzuki2, Shu-ichi Saitoh2, Yasuchika Takeishi2
1Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
2Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan

Tóm tắt

Rối loạn hô hấp trong khi ngủ (SDB) làm xấu đi tiên lượng của bệnh nhân suy tim mạn (CHF). Thông khí servo thích ứng (ASV) là một phương pháp điều trị mới để điều trị SDB, bao gồm cả hô hấp Cheyne-Stokes liên quan đến ngừng thở trung ương trong khi ngủ. Chức năng thận đóng vai trò quan trọng trong quá trình tiến triển của CHF và là một yếu tố dự đoán mạnh mẽ về các kết cục lâm sàng. Cystatin C là một dấu hiệu của chức năng thận và nhạy hơn creatinine huyết thanh. Mục đích của nghiên cứu này là xem xét liệu ASV có hiệu quả cho quá tải tim và suy chức năng thận ở bệnh nhân CHF bị SDB hay không. Năm mươi bệnh nhân bị CHF và SDB (tỷ lệ phân suất tống máu thất trái trung bình 34,0%, tỷ lệ lọc cầu thận ước tính (eGFR) 62,8 ml/phút/1,73 cm2) đã được khảo sát. Chúng tôi đã thực hiện polysomnography trong hai ngày liên tiếp (cơ bản và khi sử dụng ASV), và đo các mức độ của natriuretic peptide B kiểu N đầu cuối huyết thanh (NT-pro BNP), cystatin C, và tỷ lệ lọc cầu thận ước tính dựa trên cystatin C (eGFR Cyst C). ASV đã cải thiện đáng kể chỉ số ngưng thở - giảm thông khí, chỉ số ngưng thở trung ương, chỉ số ngưng thở tắc nghẽn, chỉ số kích thích, độ bão hòa oxy trung bình và độ bão hòa oxy thấp nhất so với cơ bản. ASV đã giảm NT-pro BNP (1.109,0 (2.173,2) xuống 912,8 (1.576,7) pg/ml, p < 0.05), cystatin C (1.391 ± 0.550–1.348 ± 0.489 mg/l, p < 0.05), và tăng eGFR Cyst C (61.9 ± 30.8–65.7 ± 33.8 ml/phút/1.73 cm2, p < 0.01). ASV cải thiện SDB, giảm quá tải tim, và cải thiện chức năng thận ở bệnh nhân CHF bị SDB. ASV có tác dụng tích cực trong ngắn hạn không chỉ trên SDB mà còn trên chức năng tim - thận. ASV có thể là một công cụ hữu ích đầy hứa hẹn cho CHF như một liệu pháp không dùng thuốc quan trọng với tác dụng bảo vệ tim - thận.

Từ khóa

#Suy tim mạn #rối loạn hô hấp trong khi ngủ #chức năng thận #thông khí servo thích ứng #chỉ số ngưng thở #quá tải tim.

Tài liệu tham khảo

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