充血性心力衰竭患者陈-施氏呼吸的发生机制-王菡侨教授-英文课件.ppt

Dai Yumino et al Proc Am Thorac Soc Vol 5. pp 226–236, 2008 1 Wang Hanqiao et al. JACC Epub 2007 Apr 2 2 Hanly PJ,et al Am J Respir Crit Care Med, 1996,153(1):272-6 SDB significantly reduce survival without cardiac transplantation (transplant-free survival) Summary In patients with HF, CSR-CSA is common and is due to respiratory control system instability secondary to the effects of elevated LV filling pressures, pulmonary congestion, increased central and peripheral chemoreceptor sensitivity, reduced cerebrovascular blood flow, and possibly other factors. Central apnea occurs when PaCO2 falls below the threshold for apnea during sleep. Although low cardiac output and increased lung to chemoreceptor circulation time have not been shown to play a direct role in precipitating central apneas, they do sculpt the hyperpneic period into the characteristic prolonged waxing-waning pattern of ventilation. The majority of the evidence indicates that CSR-CSA increases the risk of premature death in HF. This adverse effect has been most closely linked with CSR-CSA–induced sympathetic activation, although other as yet unidentified mechanisms may be involved Evidence from one multicenter randomized trial demonstrated that CPAP attenuated CSR-CSA in association with improved LV function, decreased SNA, and increased exercise performance. Further research should be done to make sure whether the therapy of CSA-CSR can improve the survival or reduced hospitalizations of CHF patients. CSR-CSA 王 菡 侨 河北医科大学第三附属医院 呼吸睡眠科 Definition of CSA  Central sleep apneas Central sleep apneas and hypopneas arise from complete or partial reductions in central neural outflow to the respiratory muscles during sleep that lead to complete or partial cessation of airflow for at least 10 seconds, respectively CSA 与OSA when studying patients with cardiovascular diseases, especially