无创通气对肥胖低通气综合征患者心肌的长期影响。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Respiratory medicine Pub Date : 2024-07-06 DOI:10.1016/j.rmed.2024.107735

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引用次数: 0

摘要

简介：人们对无创通气对肥胖低通气综合征（OHS）患者心肌功能的长期影响知之甚少。本研究旨在评估双水平气道正压通气（BiPAP）对肥胖低通气综合征患者心脏参数和心肌生物标志物的长期影响：连续纳入转诊至三级中心接受长期 BiPAP 治疗的临床稳定的 OHS 患者。基线时，所有参与者都接受了通宵心肺功能测谎。开始使用生物通气疗法，该疗法通过口鼻面罩以容量为目标的自发/定时模式进行。在使用 BiPAP 3 个月和 12 个月后，使用阻抗心电图进行逐次无创监测，以评估基线时的心脏功能。血清肌钙蛋白 1、N-末端前 B 型利钠肽 (NT-ProBNP)、肿瘤坏死因子-α (TNF-α) 和白细胞介素-6 (IL-6) 也受到监测：共招募了 13 名患者（10 名男性；平均年龄为 55.8 ± 9.8 岁；平均体重指数为 47.8 ± 5.9 kg/m2）。从基线到使用 BiPAP 3 个月和 12 个月，左心室搏出量 (SV)、射血时间 (LVET) 和射血时间指数显著增加（分别为 P = 0.030；P < 0.001；P = 0.003），而心率和收缩时间比显著下降（分别为 P = 0.004；P = 0.034）。血清NT-proBNP、IL-6和TNF-α也有所下降（分别为P = 0.045；P = 0.018；P = 0.003）。在整个研究过程中，未发现血清肌钙蛋白有明显变化：目前的研究结果表明，在使用 BiPAP 治疗一年以上的稳定型 OHS 和慢性中重度日间高碳酸血症患者中，SV 增加与 LVET 延长、NT-proBNP 降低和循环系统炎症标志物减少有关，支持这种治疗模式在此类患者中的作用。

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Long-term myocardial effects of noninvasive ventilation in patients with obesity hypoventilation syndrome

Introduction

Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS.

Methods

Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored.

Results

Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m²) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study.

Conclusions

The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.