心源性运动呼吸异常：心衰患者运动期间波浪式呼吸的临床观察  

Circulatory breathing abnormality:Clinical observation on exercise induced oscillatory breathing pattern

作　　者：张雪梅[1,2] 孙兴国[1] Piergiuseppe Agostoni 刘方[1] 周娜[1,4] 谭晓越[1] 宋桂芹[1,5] 谷磊[1,6] 刘凝华[1,7] 

机构地区：[1]中国医学科学院北京协和医学院、国家心血管病中心阜外医院、心血管疾病国家重点实验室、心血管疾病国家临床医学研究中心,北京100037 [2]江西省南昌市第一医院心内科,南昌330008 [3]米兰大学心衰中心,意大利米兰20121 [4]昆明医科大学第二附属医院心内科,云南昆明650101 [5]首都医科大学电力教学医院,北京100076 [6]北京小汤山医院,北京102200 [7]河北医科大学第四医院功能科,石家庄050000

出　　处：《中国应用生理学杂志》2015年第4期365-368,共4页Chinese Journal of Applied Physiology

基　　金：国家自然科学基金医学科学部面上项目(81470204);国家高新技术研究发展计划(863计划)课题(2012AA021009);中国医学科学院国家心血管病中心科研开发启动基金(2012-YJR02)

摘　　要：目的:探讨心力衰竭患者在运动期间诱发的异常波浪式呼吸模式(EIOB)的临床特点及发生机制。方法:回顾分析38例NYHAⅢ-Ⅳ级患者完成的症状限制性功率递增极限心肺运动试验(CPET)。观察分析计算心力衰竭患者在CPET中EIOB的发生时间、频率、振幅等临床特点。结果:本组患者男17女21在38例患者中,31例发生EIOB,发生率为81.6%。EIOB组每分通气量(V4E)波浪振幅是(12±4)L/m(为平均值的81%±30%),周期(77.0±20.0)s。EIOB组中OB发生在运动前、运动中功率低于无氧阈时、恢复期或者全程分别为24、31、4和4例;除V4E外,在CPET的各项参数中,全部31例患者均表现EIOB的指标为V4O2、V4CO2、RER和PETO2;29例患者V4E/V4 CO2、V4O2/V4E和BF出现EIOB;26例患者PETCO2出现EIOB;25例患者VT、V4O2/HR出现EIOB;2例患者HR出现EIOB。结论:严重心力衰竭患者易发生EIOB。就心脏功能对呼吸调控的影响及心衰患者呼吸异常发生机制进行了探讨。Objective： Exercise induced oscillatory ventilation （EIOB） during cardiopulmonary exercise testing （CPET） is associated with severity and prognosis of disease, but clinical approach for the character of EIOB due to circulatory dysfunction are seldom reported. Methods： This retrospective analysis of symptom-limited maximum CPET data with an increment of 10-20 W/min in 38 patients with CHE We calculated the duration, frequency, amplitude and other parameters of EIOB. Results： There were 31 presenting with EIOB （82%） in all patients with CHE In EIOB group, VE amplitude were （12.4±4.4）L/min （accounting for 81%±30% of mean） and duration were （77.0＋20.0）s. The number of patients whose EIOB presenting at rest, exercise, recovery stage and the whole period were 24, 31, 4 and 4, respectively. Except VE, there were VO, VCO2, RER and PETO2 presenting EIOB in all 31 patients; VE/ VCO2, VO2/ VE and breath frequency in 29 patients ; PETCO2 in 26 patients; VT and VOJHR in 25 patients ; and HR in 2 patients. Conclusion： EIOB may occur in any period of CPET, mostly in severe patient with CHF, and presenting in many variables. Due to it is resulted from the circulatory dysfunction, we should call it circulatory （cardiac） oscillatory breathing abnormality.

关 键 词：整体整合生理学 整体整合医学 心肺运动试验 心力衰竭 波浪式呼吸 混合室效应 时相错位效应 

分 类 号：R332.1[医药卫生—人体生理学]