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.ppt

CSR-CSA;Definition of CSA ;Central sleep apneas;CSA 与OSA;In patients with HF, a diagnosis of CSA can be established on overnight polysomnography, using either RIP or nasal pressure cannula for respiratory monitoring, when there is an AHI of at least 5 to 15, and when at least 50% of apneas and hypopneas are central.;Cheyne-Stokes respiration (CSR);;CSR can be observed both during sleep and wakefulness, although it appears to be far more common during sleep When it occurs during sleep, it is simply a form of CSA with a prolonged hyperpnea. When specifying the occurrence of CSR during sleep, we have used the term ‘‘Cheyne-Stokes respiration with central sleep apnea (CSR-CSA).’’;The presence of a prolonged hyperpnea with a waxing-waning pattern of tidal volume, and prolonged cycle duration, that distinguishes CSR from other forms of periodic breathing as idiopathic CSA or high-altitude periodic breathing without HF ;AB（apnea length） =18s ，21sC =nadir of SaO2 BC （lung-tocarotidbody circulation time）= 8 s ，26sBD (hyperpnea length) =7s，46sAD (cycle length ) =25 s, 65s Hall MJ, Am J Respir Crit Care Med 1996;154:376–381;Pathophysiolory;hyperventilation; In patients with HF with CSR-CSA, PaCO2 tends not to increase much more from wakefulness to sleep compared to the apneic threshold does. Loop gain Xie A et al, Am J Respir Crit Care Med 2002;165:1245–1250. Ferrier K et al, Chest 2005;128:2116–2122.;This chronic hyperventilation occurs because of pulmonary vagal irritant receptor stimulation by pulmonary congestion and increases in central and peripheral chemosensitivity. Lowering wedge pressure with drugs or CPAP is associated with a rise in PaCO2 and alleviation of CSRCSA. Solin Pet al Circulation 1999;99:1574–1579. Javaheri S. N Engl J Med 1999;341:949–954. Solin P et al, Am J Respir Crit Care Med 2000;162:2194–2200. ;arousals;CSA 与OSA;; ;;Prevalence;;;Risk factors for CSA in CHF;Cardiovascular Effects of CSR-CSA;CSR-CS