Zusammenfassung
Die kongestive Kardiomyopathie mit Cheyne-Stokes-Atmung (CSA) ist mit einer hohen
Mortalitätsrate assoziiert. Continuous positive airway pressure (CPAP) bessert die
Prognose. Wir berichten in dieser retrospektiven Untersuchung über unsere Ergebnisse
zur Differenzialtherapie mit unterschiedlichen Positivdruckverfahren bei CSA. Der
Beobachtungszeitraum reichte von 1995-1999. Einschlusskriterien waren ein Respiratory
Disturbance Index > 10/h und mehr als 50 % zentrale und/oder gemischtförmige Apnoen.
Jeder Patient wurde über jeweils 4 Wochen mit CPAP, Bilevel CPAP im Spontanmode (d.
h. BiPAP S oder ST Modus) und BiPAP im kontrollierten Mode (d. h. BiPAP T) behandelt.
Responder für das jeweilige Positivdruckverfahren wurden nach subjektiven und objektiven
Kriterien definiert. Es wurden 41 männliche Patienten eingeschlossen. Die Responder
verteilten sich folgendermaßen: CPAP: n = 13 Patienten (31,7 %), BiPAP S/ST: n = 9
Patienten (22,0 %) und BiPAP T: n = 12 Patienten (29,3 %). Insgesamt 7/41 Patienten
(17,1 %) lehnten eine langfristige Therapie mit einem Positivdruckverfahren ab. Die
überwiegende Mehrheit der Patienten mit CSA lässt sich mit CPAP bzw. BiPAP S/ST befriedigend
einstellen. Auch wenn sich in der BiPAP-T-Respondergruppe die Atmung im Schlaf weitgehend
normalisierte, kam diese Beatmungsform langfristig nur bei etwa 29 % der Patienten
zur Anwendung.
Abstract
Cheyne-Stokes respiration (CSR) is found in patients with chronic left ventricular
failure and associated with a reduced prognosis. Continuous positive airway pressure
(CPAP) improves the survival rate. In this retrospective study we report on the effect
of different positive pressure ventilation modes in CSR. The observation period lasted
from 1995 - 1999. Inclusion criteria was CSR with a respiratory disturbance index
> 10/h whereas > 50 % of the events had to be central and/or mixed. In each patient
a 4 week lasting intervention with each of CPAP, Bilevel CPAP in spontan mode (i.e.
BiPAP S or BiPAP ST) and BiPAP in controlled mode (i.e. BiPAP T) was performed. Responder
were defined by subjective and objective criteria. In total 41 males were included.
Responder were distributed as follows: CPAP: n = 13 patients (31.7 %), BiPAP S/ST:
n = 9 patients (22.0 %) and BiPAP T: n = 12 patients (29.3 %). In total 7 from 41
patients (17.1 %) rejected a long-term treatment with positive pressure ventilation.
The majority of patients with CSR responded to CPAP and BiPAP S/ST mode. Compared
to the other responder groups the best quality was reached with BiPAP T. However the
latter was performed only by 29 % of the population.
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PD Dr. B. Schönhofer
Edward Hines Jr., VA and Loyola University, Chicago Division of Pulmonary and Critical
Care Medicine
Building 1, Room E438, Route 111N
Hines, IL 60078, USA
Email: Bernd.Schoenhofer@t-online.de
