无创正压通气不同压力水平对慢性阻塞性肺疾病患者呼吸生理参数的影响  

Effect of levels of noninvasive positive pressure ventilatin on respiratory physiological parameters in patients with COPD

作　　者：黎毅敏[1] 李缨[2] 罗群[1] 陈思蓓[1] 李寅环[1] 陈荣昌 

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,广州510260

出　　处：《中国实用内科杂志》2004年第12期728-730,共3页Chinese Journal of Practical Internal Medicine

基　　金：卫生部科学研究基金 (98-1-3 47);广州市科技局项目 (98-K -0 0 1-0 1)

摘　　要：目的　观察无创正压通气 (NIPPV)不同压力水平对慢性阻塞性肺疾病 (COPD)患者呼吸生理参数的影响 ,为临床合理地应用NIPPV提供理论依据。方法　 2 0 0 0 - 0 3～ 2 0 0 4 - 0 3广州呼吸疾病研究所对 9例急性加重期COPD患者应用NIPPV治疗 ,以 9名健康志愿者作为对照 ,分别在低吸气压力支持 (IPAP)、“最舒适”IPAP和高IPAP三个压力水平通气 15min以上 ,比较不同压力水平呼吸生理参数的改变。结果　COPD组及正常对照组最舒适的IPAP为 (13 11± 2 8)cmH2 O(1cmH2 O =0 0 98kPa)及 (11 33± 3 2 0 )cmH2 O ,呼气压力支持 (EPAP)为 (4 33± 0 5 0 )cmH2 O及 (4 5 6± 0 88)cmH2 O ,两组比较差异均无显著性 (P均 >0 0 5 )。两组受试者均提示 ,与自主呼吸相比 ,NIPPV增加分钟通气量 (VE)的同时 ,总的呼吸做功 (Wtot)明显增加 (P <0 0 5 ) ,而吸气肌做功占总的吸气做功的百分比 (Wi,p/Wi)明显减少 (P <0 0 5 )。在最舒适IPAP时 ,COPD组Wi,p/Wi降低到基础值的 (15± 14 ) %。这种变化趋势与IPAP的水平正相关。 结论　NIPPV可以显著降低急性发作期COPD患者的吸气肌肉做功。吸气肌做功减少的比例与IPAP的水平相关。Objective To evaluate the pressure support levels in non-invasive positive pressure ventilation (NIPPV), the ventilatory response and work of breathing (WOB) with different levels of pressure support in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after regular treatment.Methods 9 AECOPD patients were enrolled in the study and 9 normal volunteers served as controls.The most comfortable level of inspiratory pressure (cIPAP) was chosen according to the subject’s feeling after a trial of different levels of IPAP.On the basis of cIPAP,a 25% increase or decrease of IPAP (hIAPA and lIPAP) was set.The three levels of IPAP were used for the NIPPV with 15 minutes duration for each level.Work of breathing (WOB) was measured and lung volume monitored on the basis of Campbell's diagram.Results It showed that both in COPD group and the control group, cIPAP were 13.11±2.89 (correspondingly appropriate pressure support level was 8.78±3.03 cmH 2O) and 11.33±3.20 cmH 2O respectively,and the appropriate expiratory pressure (EPAP) was 4.33±0.50 vs. 4.56±0.88 cmH 2O.There were no significant difference between the two groups.With appropriate pressure level,NIPPV could increase tidal volume and inspiratory flow significantly while decrease the work of breathing by the inspiratory muscles by 86% 9% in COPD group.Conclusion In the AECOPD patients,NIPPV is helpful to reduce the WOB,and the decrease proportion of inspiratory muscles load is related to the pressure level.

关 键 词：无创正压通气 压力水平 慢性阻塞性肺疾病 呼吸生理 吸气肌 

分 类 号：R563[医药卫生—呼吸系统] R459.6[医药卫生—内科学]