慢性阻塞性肺疾病急性发作期患者对比例辅助通气的生理反应  

Physiologic response to proportional assist ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：罗群[1] 李缨[2] 陈荣昌 郑则广[1] 李寅环[1] 秦朝辉[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所,510120 [2]广州医学院第二附属医院急诊科

出　　处：《中华结核和呼吸杂志》2004年第11期743-747,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：广州市科技局科研基金项目 [(JB0 2 ) 2 0 0 1 Z 0 3 6 0 1 1]

摘　　要：目的　探讨比例辅助通气 (PAV)不同辅助水平对慢性阻塞性肺疾病 (COPD)急性发作期患者生理反应的影响。方法　 9例COPD急性发作期患者接受三个不同比例辅助水平的PAV通气 ,观察患者吸气肌肉用力情况和呼吸方式的变化。结果　 (1)与自主呼吸 (SB)相比 ,PAV各辅助水平时的潮气量 (VT)、分钟通气量 (V·E)和呼吸频率 (RR)均稍增高 (P >0 0 5 )。各比例辅助水平之间的VT、V·E 和RR比较差异无显著性 (P >0 0 5 )。 (2 )与SB相比 ,各比例辅助水平时的跨膈压 (Pdi)、压力时间乘积 (PTP)和患者呼吸做功均明显减少 (P >0 0 1) ,Pdi、PTP和患者呼吸做功分别平均减少 8 36cmH2 O、11 4 9cmH2 O·s-1·L-1和 0 5 3J/L。随比例辅助水平的升高 ,Pdi、PTP和患者呼吸功无明显变化(P >0 0 5 )。 (3)PAV可减轻患者呼吸困难 (P <0 0 5 )。结论　本试验证实了无创PAV在COPD急性发作期患者中应用的可行性。患者感觉最舒适的PAV辅助比例水平是 (5 7± 11) %。根据患者感觉舒适情况而设定比例辅助水平的无创PAV可减轻患者的呼吸肌肉负担 ,最舒适水平时呼吸功减少5 7% ,Pdi减少 72 % ,PTP减少 6 5 % ;Objective To investigate the effect of different assist levels during proportional assist ventilation(PAV) on patients with acute exacerbation of chronic obstructive pulmonary disease(COPD). Methods Nine patients with acute exacerbation of COPD received different levels of assist ventilation during PAV. The change of inspiratory muscle effort and breathing pattern of the patients were observed. Results (1)The average tidal volume(V T), minute ventilation( V · E) and respiratory frequency(RR) were slightly higher during PAV,as compared to spontaneous breathing(SB). The change of breathing pattern of the patients was not significant at different assist levels during PAV. (2)The transdiaphragmatic pressure(Pdi),the pressure-time product(PTP) and work of breathing(Wi) reduced significantly during PAV as compared with SB(differently reduced 8.36 cm H 2O,11.49 cm H 2O·s -1·L -1 and 0.53 J/L). The change in Pdi,PTP and Wi was small among different levels during PAV. (3)Dyspnea was improved during PAV. Conclusions The present study confirms the feasibility of noninvasive ventilation PAV in treating patients with acute exacerbation of COPD. Based on the patient′s assessment,the ventilatory support level which the patients could comfortably tolerate was (57±11)%. noninvasive ventilation PAV set at a level of comfort determined by the patient can unload inspiratory muscles;at the comfortable level of ventilatory support,Wi,Pdi and PTP decreased by 57%,72% and 65% respectively. It also improved breathing pattern and dypnea.

关 键 词：患者 急性发作期 PAV 比例辅助通气 COPD 慢性阻塞性肺疾病 无创 做功 情况 水平 

分 类 号：R563.9[医药卫生—呼吸系统]