Effective non-invasive ventilation reduces muscle sympathetic nerve activity in patients with stable hypercapnic COPD

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Autonomic Research Pub Date : 2024-03-19 DOI:10.1007/s10286-024-01027-2

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引用次数: 0

Abstract

Increased sympathetic drive is of prognostic significance in chronic obstructive pulmonary disease (COPD) but its determinants remain poorly understood. One potential mechanism may be chemoreflex-mediated adrenergic stimulation caused by sustained hypercapnia. This study determined the impact of non-invasive ventilation (NIV) on muscle sympathetic nerve activity (MSNA) in patients with stable hypercapnic COPD. Ten patients (age 70 ± 7 years, GOLD stage 3–4) receiving long-term NIV (mean inspiratory positive airway pressure 21 ± 7 cmH₂O) underwent invasive MSNA measurement via the peroneal nerve during spontaneous breathing and NIV. Compared with spontaneous breathing, NIV significantly reduced hypercapnia (PaCO₂ 51.5 ± 6.9 vs 42.6 ± 6.1 mmHg, p < 0.0001) along with the burst rate (64.4 ± 20.9 vs 59.2 ± 19.9 bursts/min, p = 0.03) and burst incidence (81.7 ± 29.3 vs 74.1 ± 26.9 bursts/100 heartbeats, p = 0.04) of MSNA. This shows for the first time that correcting hypercapnia with NIV decreases MSNA in COPD.

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有效的无创通气可降低慢性阻塞性肺疾病稳定期高碳酸血症患者的肌肉交感神经活动

摘要交感神经驱动增加对慢性阻塞性肺病（COPD）的预后具有重要意义，但其决定因素仍鲜为人知。一个潜在的机制可能是持续高碳酸血症引起的化学反射介导的肾上腺素能刺激。本研究确定了无创通气（NIV）对稳定型高碳酸血症慢性阻塞性肺病患者肌肉交感神经活动（MSNA）的影响。十名长期接受无创通气（平均吸气气道正压为 21 ± 7 cmH2O）的患者（年龄 70 ± 7 岁，GOLD 3-4 期）在自主呼吸和无创通气过程中通过腓总神经进行了有创 MSNA 测量。与自主呼吸相比，NIV 显著降低了高碳酸血症（PaCO2 51.5 ± 6.9 vs 42.6 ± 6.1 mmHg，p < 0.0001）以及 MSNA 的爆发率（64.4 ± 20.9 vs 59.2 ± 19.9 爆发/分钟，p = 0.03）和爆发发生率（81.7 ± 29.3 vs 74.1 ± 26.9 爆发/100 次心跳，p = 0.04）。这首次表明，使用 NIV 纠正高碳酸血症会降低 COPD 患者的 MSNA。

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来源期刊

Clinical Autonomic Research 医学-临床神经学

CiteScore

7.40

自引率

6.90%

发文量

审稿时长

>12 weeks

期刊介绍： Clinical Autonomic Research aims to draw together and disseminate research work from various disciplines and specialties dealing with clinical problems resulting from autonomic dysfunction. Areas to be covered include: cardiovascular system, neurology, diabetes, endocrinology, urology, pain disorders, ophthalmology, gastroenterology, toxicology and clinical pharmacology, skin infectious diseases, renal disease. This journal is an essential source of new information for everyone working in areas involving the autonomic nervous system. A major feature of Clinical Autonomic Research is its speed of publication coupled with the highest refereeing standards.