慢性阻塞性肺疾病患者采用压力支持通气模式撤机时调节压力上升时间对呼吸形态的影响  

Effect of different inspiratory rise time during pressure support ventilation in patients recovering from acute exacerbations of chronic obstructive pulmonary disease

作　　者：王艳茹[1] 潘文森[2] 许晓岚[2] 张鲁涛[2] 

机构地区：[1]冀州市医院内二科,河北冀州053200 [2]河北医科大学第二医院呼吸科,河北石家庄050000

出　　处：《临床荟萃》2011年第5期376-379,共4页Clinical Focus

摘　　要：目的探讨不同压力上升时间设定对采用压力支持通气模式(PSV)撤机的慢性阻塞性肺疾病(COPD)患者的影响。方法对23例因呼吸衰竭已经气管插管机械通气并至恢复期的COPD患者进行压力支持通气,采用自身前后对照方法,先后给予较短压力上升时间和较长压力上升时间两种设定,观察患者呼吸形态、生命体征和呼吸困难情况。结果从较短压力上升时间至较长压力上升时间潮气量增加(0.45±0.08)L vs(0.49±0.10)L、吸气时间延长(0.92±0.13)秒vs(0.49±0.10)秒、吸气峰值流速减小(53.92±8.33)L/min vs(41.69±7.53)L/min、气道闭合压增大(1.88±0.08)mmHg vs(3.16±0.90)mmHg、视觉模拟评分(VAS)增加(1.69±0.85)分vs(2.77±0.73)分及Borg量表评分增加(1.27±0.75)分vs(2.85±0.99)分(P<0.05或<0.01)。VAS评分、Borg量表与气道闭合压呈正相关(r=0.510、0.640,均P<0.05)。结论对准备撤机的COPD患者进行PSV模式通气,选用较短的压力上升时间与较长的压力上升时间相比,能减少患者呼吸功,较少引起呼吸困难。利用气道闭合压、VAS评分和Borg量表有助于选择合适的压力上升时间,利于撤机。Objective To explore the effects of different inspiratory rise time in patients recovering from acute exacerbation of chronic obstructive pulmonary disease.Methods 23 patients of acute exacerbation of chronic obstructive pulmonary disease were ventilated with pressure support ventilation at two different inspiratory rise time in turn.The parameters in two conditions of respiration,the vital signs and scales of dyspnea were monitored and compared.Results From the shorter to the longer inspiratory rise time,the tidal volume became bigger,inspiratory time extended,the inspiratory peak flow decreased,airway occlusion pressure increased,the visual analogue score and Borg score of dyspnea exacerbated（P0.05 or 0.01）.The visual analogue score and Borg score of dyspnea positively correlated with airway occlusion pressure.The coefficients of correlation were 0.510 and 0.640 respectively（both P0.05）.Conclusion To patients recovering from acute exacerbations of chronic obstructive pulmonary disease,ventilation with pressure support ventilation at the shorter inspiratory rise time decreases the effort of breathing and the scales of dyspnea.Airway occlusion pressure,the visual analogue score and Borg score of dyspnea may be helpful to select appropriate inspiratory rise time.

关 键 词：肺疾病 慢性阻塞性 呼吸 人工 呼吸困难 气道闭合压 呼吸功 

分 类 号：R563.8[医药卫生—呼吸系统]