无创正压通气对急性肺损伤早期气体交换和呼吸应答的影响  

作　　者：陈新[1] 陈瑞[2] 许睿[3] 刘杰[4] 于化鹏[1] 

机构地区：[1]南方医科大学珠江医院呼吸内科,510282 [2]中山大学附属第二医院呼吸内科,510120 [3]南方医科大学珠江医院麻醉科 [4]广州医学院第一附属医院广州呼吸疾病研究所,510120

出　　处：《当代医学》2011年第31期1-3,共3页Contemporary Medicine

基　　金：广东省医学科研基金(A2008429)

摘　　要：目的探讨无创正压通气对急性肺损伤(ALI)早期气体交换和呼吸应答的影响。方法 40例早期ALI患者,分为无创正压通气组(NIPPV)和控制性高浓度氧疗组。在入选时和入选后2、12、24、48、72h连续记录并计算气体交换和呼吸应答的各项生理参数。结果 NIPPV组与氧疗组比较,氧合指数(OI)明显升高(P<0.05～0.001),呼吸频率(RR)和浅快呼吸指数(f/VT)明显降低(P<0.05～0.001),分钟通气量(VE)显著降低(P<0.05),平均吸气流速(VT/Ti)和气道阻力(Raw)显著降低(P<0.05～0.001),生理死腔与潮气量之比(VD/VT)显著降低(P<0.01～0.001)。两组间潮气量(VT)、吸气时间占呼吸周期比值(Ti/Ttot)、动态顺应性(Cdyn)无显著性差异(P>0.05)。结论 ALI早期应用NIPPV可显著改善ALI患者气体交换和呼吸应答方式,纠正低氧血症,缓解呼吸窘迫,降低了患者的通气需求和中枢驱动。Objective To evaluate the effects of non-invasive positive pressure ventilation （NIPPV） on gas exchange and respiratory response in early stage of patients with acute lung injury （ALI）.Methods 40 patients in early stage of ALI,were randomly divided into two groups i.e.NIPPV group and controlling high concentration oxygen therapy group.Monitoring and calculated parameters on gas exchange and respiratory response at baseline point,2th,12th,24th,48th and 72th hour after treatment were recorded on a continuous basis in time sequence.Results Comparing with controlling high concentration oxygen therapy group,NIPPV group had most significant effects on increasing OI （P0.05～0.001） and reducing RR,f/VT （P0.05～0.001）,VE （P0.05）,VT/Ti and Raw （P0.05～0.001）.There was no obvious difference on VT,Ti/Ttot and Cdyn between two groups （P0.05）.Conclusion NIPPV made active effects on improving gas exchange and respiratory response patterns meanwhile correcting hypoxemia,releasing dyspnea and reducing the requirement of ventilation and central drive of ALI patients.

关 键 词：急性肺损伤 无创正压通气 气体交换 

分 类 号：R563.8[医药卫生—呼吸系统]