pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2009-3-37-42pulmo-1545Research ArticleСтатьиСравнение эффективности режимов неинвазивной вентиляции легких при декомпенсации хронической сердечной недостаточностиПоповаК.А.noemail@neicon.ruАвдеевС.Н.noemail@neicon.ruНеклюдоваГ.В.noemail@neicon.ruФГУ НИИ пульмонологии ФМБА РоссииRussian Federation200928062009033742Copyright © Попова К., Авдеев С., Неклюдова Г., 20092009Попова К., Авдеев С., Неклюдова Г.Попова К., Авдеев С., Неклюдова Г.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1545

Было проведено сравнительное рандомизированное перекрестное контролируемое исследование режимов неинвазивной вентиляции легких (НВЛ) - СРАР и BiPAP - для сравнения их влияния на показатели центральной гемодинамики у больных с декомпенсацией хронической сердечной недостаточности (ХСН). Критериями включения в исследование больных, госпитализированных в стационар, были: декомпенсация ХСН, возникшая на фоне ишемической болезни сердца или дилатационной кардиомиопатии; фракция выброса левого желудочка (ЛЖ) < 35; III-IV функциональный класс, по NYHA; возраст > 40 лет; нарастание одышки в течение периода < 7 дней и ортопноэ; рентгенографические признаки кардиомегалии и венозного застоя. В исследование были включены 19 пациентов (11 мужчин и 8 женщин) с декомпенсацией ХСН. Средний возраст - 56,11 ± 11,91 года, средний индекс массы тела - 27,67 ± 6,14 кг/м2. Больные случайным методом были рандомизированы, после чего им проводилась НВЛ в режиме СРАР - 7,5 см вод. ст. или BiPAP (PS / PEEP) - 10 / 5 см вод. ст. При проведении НВЛ в режиме BiPAP в течение 30 мин отмечалось достоверное снижение частоты дыхания (ЧД) и сердечных сокращений (ЧСС) (р < 0,01), увеличение фракции выброса (р < 0,01) и ударного объема (р < 0,01), уменьшение систолического давления в легочной артерии (р < 0,05), снижение трикуспидальной и митральной регургитации (р < 0,05) и положительные изменения индекса Tei (р < 0,05), отражающего глобальную систоло-диастолическую функцию миокарда. При проведении НВЛ в режиме СРАР также отмечалось снижение ЧД (р < 0,05), ЧСС (р < 0,01), улучшение гемодинамических показателей, однако изменение индекса Tei не являлось достоверным. Таким образом, режимы НВЛ СРАР и BiPAP достоверно улучшают показатели сердечной гемодинамики у больных с декомпенсацией ХСН, однако BiPAP более значимо влияет на интегральный индекс систоло-диастолической функции ЛЖ.

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The authors declare that there are no conflicts of interest present.