慢性阻塞性肺疾病患者辅助机械通气时呼气末正压水平对呼气末肺容量的影响  

Effects of positive end-expiratory pressure level on end-expiratory lung volume during assisted ventilation in chronic obstructive pulmonary disease

作　　者：秦朝辉[1] 陈荣昌 钟南山[2] 

机构地区：[1]烟台毓璜顶医院呼吸科,山东烟台264001 [2]广州医学院第一附属医院广州呼吸疾病研究所

出　　处：《中国呼吸与危重监护杂志》2007年第1期23-26,44,I0001-I0002,共7页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：广东省自然科学研究基金(编号:31755)

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)辅助机械通气时呼气末正压(PEEP)水平对呼气末肺容量(EELV)的影响规律,为临床合理设定PEEP水平提供依据。方法8例因COPD急性加重(AECOPD)进行插管通气治疗后病情相对稳定的病人,用呼气末阻断法和食道囊管法分别检测静态内源性呼气末正压(PEEPistat)和动态内源性呼气末正压(PEEPidyn),用最大深吸气量(IC)法检测EELV的变化(ΔEELV),用参数估计法分析PEEP与ΔEELV的关系。结果随着PEEP的增加,ΔEELV呈S型曲线变化规律。采用最大斜率分析方法,寻找S型曲线陡直上升段起始点,分别是PEEP/PEEPistat=0.74,PEEP/PEEPidyn=0.76,相当于PEEP实际值为3.6cmH2O;对应的ΔEELV/IC(%)分别为9.6%,9.1%和7.4%。结论对于实施机械通气的AECOPD患者,PEEP水平增加与ΔEELV呈S型曲线变化规律,按照PEEPistat的0.74或PEEPidyn的0.76设定PEEP水平,可以避免出现ΔEELV陡直上升。Objective To investigate the effects of positive end-expiratory pressure （PEEP） level on end-expiratory lung volume （EELV） during assisted ventilation in chronic obstructive pulmonary disease （COPD） patients,to provide physiological evidence to guide optimal setting of PEEP level in clinical practice. Methods Eight intubated patients with acute exacerbation of COPD were recruited for the study when the patients were in relatively stable condition after treatment. The static intrinsic PEEP （PEEPistat） and dynamic intrinsic PEEP （PEEPidyn） were measured by using airway occlusion method and esophageal balloon-tipped catheter technique, respectively. Changes in EELV （ΔXEELV） were measured with inspiratory capacity （IC） method. Relations between PEEP level and ΔEELV were analyzed by curve estimation method. Results ΔEELV as a function of level of PEEP was shown as a signoid model. The low inflection points of the curves when PEEP levels were expressed as PEEP/PEEPistat ratio,PEEP/PEEPidyn ratio or actual PEEP setting （PEEP-a） were 0.74,0.76 or 3.6 cm H2O, respectively. The corresponding ΔEELV expressed as ΔEELV/IC（ % ） were 9.6%,9.1% and 7.4% ,respectively. Conclusions In AECOPD patients demanding mechanical ventilation, the changes of lung volume （ΔEELV） in response to progressive increase of PEEP level were shown to be a signoid model. Setting PEEP level at 0.74 of PEEPistat,or 0.76 of PEEPidyn can avoid the steep increase of lung volume.

关 键 词：慢性阻塞性肺疾病 呼气末正压 肺容量 

分 类 号：R563.9[医药卫生—呼吸系统]