emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.2.1644emcardio-80Research ArticleОригинальные научные публикацииOriginal Scientific ResearchДифференциальная диагностика хронической сердечной недостаточности и хронической дыхательной недостаточности у пациентов с хронической обструктивной болезнью легкихDifferential diagnosis of chronic heart failure and chronic respiratory failure in patients with chronic obstructive pulmonary diseaseЛапицкийД. В.LapitskiD.

Минск

Minsk

lapitskiy1973@mail.ruГосударственное учреждение «432 Главный военный клинический медицинский центр МО ВС Республики Беларусь»Main Military Clinical Medical Center of the Ministry of Defense of the Republic of Belarus2022230620256216441660Copyright © Лапицкий Д.В., 20252025Лапицкий Д.В.Lapitski D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/80

Главной причиной смертности пациентов с хронической обструктивной болезнью легких (ХОБЛ) традиционно считалась хроническая дыхательная недостаточность (ХДН). Однако современные эпидемиологические исследования показали, что ведущими причинами, уносящими жизни пациентов с ХОБЛ, являются ишемическая болезнь сердца (ИБС) и хроническая сердечная недостаточность (ХСН).Цель: изучить распространенность ХДН и ХСН у пациентов с ХОБЛ, определить информативность клинических симптомов в их диагностике, выработать алгоритм дифференциальной диагностики ХСН и ХДН.Методы: объект исследования – 100 мужчин с ХОБЛ. Медиана возраста – 67 лет. Проведено клинико-лабораторное обследование. Синдром ХСН диагностирован по результатам ЭхоКГ и NT-proBNP. Синдром ХДН устанавливался по результатам нагрузочного тестирования с одновременным измерением насыщения гемоглобина артериальной крови кислородом.Результаты: ХСН установлена у 45,0% пациентов, в 42,0% случаев диагностирована правожелудочковая недостаточность. Пациенты с ХСН и снижением фракции выброса (ФВ) левого желудочка, прогноз у которых способно улучшить разработанное на современном этапе с позиций доказательной медицины лечение, составили всего 12,0%. Показана взаимосвязь синдрома ХСН с синдромом ХДН и нарушениями насыщения гемоглобина артериальной крови кислородом: с ХСН NYHA III ассоциирована степень ХДН IIIБ и любые нарушения насыщения гемоглобина артериальной крови кислородом, с ХСН NYHA II и NYHA I ассоции- рованы степени ХДН IIIA и ХДН IIБ соответственно, а также снижение насыщения гемоглобина артериальной крови кислородом как при нагрузке, так и в покое. Проведена оценка информативности клинической симптоматики у пациентов с ХОБЛ в диагностике синдромов ХСН и ХДН: вероятность диагностики ХСН по клиническим симптомам составляет 79,0%, ХДН – 88,0%. Разработана шкала с оценкой симптомов в баллах и алгоритм диагностики ХСН и ХДН.

Chronic respiratory failure (CRF) has traditionally been considered to be the main cause of death in patients with chronic obstructive pulmonary disease (COPD). However, modern epidemiological studies have shown that the leading causes of death in patients with COPD are CHD and chronic heart failure (CHF).Aim: to study the prevalence of CRF and CHF in patients with COPD, to determine the informative value of clinical symptoms in their diagnosis, to work out an algorithm of differential diagnosis of CRF and CHF.Methods: subjects – 100 men with COPD. The median age was 67 years. We performed clinical and laboratory examinations. COPD syndrome was diagnosed upon EchoCG and NT-proBNP results. CRF syndrome was diagnosed by the results of exercise testing with simultaneous measurement of arterial blood hemoglobin oxygen saturation.Results: CHF was established in 45.0% of patients, and right ventricular failure was diagnosed in 42.0% of cases. Patients with CHF and decreased left ventricular ejection fraction (EF), whose prognosis could be improved by evidence-based treatment developed at the present stage, comprised only 12.0%. We revealed the correlation of CHF syndrome with CRF and with disorders of arterial blood hemoglobin oxygen saturation: CHF NYHA III is associated with CRF IIIB and any disorders of arterial blood hemoglobin oxygen saturation, while CHF NYHA II and NYHA I are respectively associated with CRF IIIA and CRF IIB as well as with a decrease in arterial blood hemoglobin oxygen saturation both on exertion and at rest. The informative value of clinical symptomatology was assessed in COPD patients for the diagnosis of CHF and CRF syndromes: the probability of CHF diagnosis based on clinical symptoms is 79.0% and for CRF – 88.0%. A symptom score scale and an algorithm for the diagnosis of CHF and CRF were developed.

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