无创正压通气治疗慢性阻塞性肺疾病急性加重期患者呼吸肌疲劳的随机对照研究  

Effects of noninvasive positive pressure ventilation on respiratory muscle fatigue in patients with acute exacerbations of chronic obstructive pulmonary disease:a randomized controlled trial

作　　者：孙丽华[1] 谭焰[1] 赵红东[2] 唐冰[2] 乔岩[1] 

机构地区：[1]南京医科大学附属南京第一医院呼吸科,210006 [2]南京医科大学附属南京第一医院神经科,210006

出　　处：《中华内科杂志》2007年第12期992-995,共4页Chinese Journal of Internal Medicine

基　　金：南京市科技发展计划(200301091-4)

摘　　要：目的评价无创正压通气(NPPV)对慢性阻塞性肺疾病(COPD)急性加重期患者呼吸肌疲劳的影响。方法采用前瞻性随机对照研究,将32例 COPD 患者随机分为Ⅰ组和Ⅱ组。Ⅰ组为常规治疗+NPPV,Ⅱ组仅接受常规治疗,观察2组治疗前后辅助呼吸肌动用评分、呼吸困难评分、肺功能、动脉血气、口腔闭合压和膈神经运动传导的变化。结果治疗前2组患者均存在呼吸困难和辅助呼吸肌参与,口腔闭合压明显高于健康人,膈神经传导的潜伏期与健康人无显著差异,但动作电位的波幅明显低于健康人。治疗第8天,2组患者的症状均改善,Ⅰ组 PaCO_2降低了(31.0±17.6)mm Hg(1 mm Hg=0.133 kPa),与Ⅱ组比较,差异有统计学意义(P<0.01)。Ⅰ组患者肺功能亦显著改善,而Ⅱ组仅第1秒钟用力呼气容积有增加。Ⅰ组患者的口腔闭合压下降了(2.8±1.0)cm H_2O(1 cm H_2O=0.098 kPa),Ⅱ组仅下降了(0.3±0.5)cm H_2O。Ⅰ组患者的膈神经动作电位的波幅亦较Ⅱ组显著增高。结论 COPD 急性加重期患者治疗前均存在不同程度的呼吸肌疲劳,应用 NPPV能改善气体交换,迅速缓解呼吸肌疲劳。Objective To study the effects of noninvasive positive pressure ventilation （NPPV） on respiratory muscle fatigue in patients with acute exacerbations of chronic obstructive pulmonary disease （COPD）. Methods Thirty-two COPD patients were randomly assigned to group Ⅰ （ conventional therapy ＋ NPPV） and group Ⅱ （ conventional therapy alone）. Sixteen normal volunteers served as the healthy control group（ normal lung function）. Scale for accessory muscle use, dyspnea score, lung function, arterial blood gases, P0.1 and phrenic nerve conduction were measured before and after the treatment. Results Before treatment, dyspnea and accessory muscle use were present in group Ⅰ and group Ⅱ. P0. 1 in the two groups was higher than that in the normal volunteers. Phrenic nerve conduction latency showed no significant difference among the three groups, but the diaphragmatic compound muscle action potential in group Ⅰ and group Ⅱ were lower than that in the normal volunteers （P 〈0.01 ）. On the 8th day of treatment, symptoms improved in both group Ⅰ and group Ⅱ. PaCO2 showed a decreased of （31.0 ± 17.6） mm Hg in group I , the difference being significant compared to group Ⅱ（ P 〈 0. 05 ）. All the parameters of lung function improved in group I , but only forced expired volume in one second （FEV1 ） increased in group Ⅱ. Compared with group Ⅱ , the Po. m in group I decreased significantly [ （ 2. 8 ± 1.0） cm H2O vs （ 0. 3 ± 0. 5 ） cm H2O, P 〈 0.01 ], and the diaphragmatic compound muscle action potential increased significantly after treatment [ left： （ 188 ＋ 62） μN vs （ 138 ± 50） μV, P 〈 0. 05 ; right ： （ 200 ± 52 ） μN vs （ 150 ± 52 ）μN, P 〈0. 01 ]. Conclusion Respiratory muscle fatigue was evident in patients with acute exacerbations of COPD. NPPV led to a more rapid improvement in gas exchange and respiratory muscle fatigue.

关 键 词：正压呼吸 肺疾病 阻塞性 肌疲劳 

分 类 号：R563.9[医药卫生—呼吸系统]