不同机械通气模式对慢性阻塞性肺病患者呼吸曲线的影响  

Influence of Different Ventilating Modes on Respiratory Curves of Patients with Chronic Obstructive Pulmonary Diseases

作　　者：姜辉[1] 王军[2] 钟雷[3] 俞森洋[4] 王立万[4] 

机构地区：[1]广州军区武汉总医院干部病房一科,湖北武汉430070 [2]广州军区武汉总医院血液科,湖北武汉430070 [3]广州军区武汉总医院门诊部,湖北武汉430070 [4]解放军总医院南楼呼吸科

出　　处：《华南国防医学杂志》2013年第9期655-658,共4页Military Medical Journal of South China

基　　金：全军医学科研"十一五"计划项目(06MA133)

摘　　要：目的比较双相气道正压通气（bi-phasic positive airway pressure，BIPAP）、自动变流（autoflow）以及间歇正压通气（intermittentpositivepressureventilation，IPPV）三种模式对慢性阻塞性肺病（chronicobstruetivepulmonarydisease，COPD）患者流速一容积曲线（Flow-Volumecurve，F-V曲线）、二氧化碳时间（和容积）曲线的影响。方法21例机械通气超过24h病情稳定的COPD患者，年龄81～91（85．1±3．0）岁。按随机顺序先后接受BIPAP、autoflow和IPPV机械通气，分别记录不同通气模式时各种呼吸力学参数。结果IPPV在吸气75％潮气量以及吸气峰流速时气道压以及流速显著高于BIPAP和Autoflow。三种通气模式对F-V曲线呼气支各点的流速无统计学意义。线性回归分析表明内源性呼气末正压（intrinsicpositiveend-expiratorypressure，PEEPi）与呼气末气体陷闭容量（Vtrap）、呼气末流速相关。三种通气模式对CO2-时间或容积曲线的Ⅲ相斜率、CO2产量、重复吸入CO2量以及呼气末CO2分压在各组间差异无统计学意义。Autoflow和BIPAP的气道死腔高于IPPV，CO2容积曲线Ⅲ相斜率与阻力和PEEPi明显相关，CO2时间曲线Ⅲ相斜率与阻力、PEEPi以及呼气峰流速明显相关。结论F-V曲线吸气支的形状明显受通气模式的影响。三种通气模式对F-V曲线呼气支无影响。三种通气模式对CO2-时间或容积曲线无影响，Autoflow和BIPAP时气道死腔增加。Objective To compare the influence of flow-volume curves, volumetric and time capnography on the patients with chronic obstructive pulmonary diseases （COPD） using hi-phase positive airway pressure （BIPAP）, autoflow and intermittent positive pressure ventilation （IPPV）. Methods A total of 21 COPD patients with stable condition and mechanically ventilated for more than 24 hours who were 81-91 （85. 1 ± 3.0） years old randomly received IPPV, BIPAP and autoflow respectively. The respiratory mechanics parameters during ventilation were recorded. Results The airway pressure and flow rate at 75 % tidal volume and the peak velocity during IPPV were significantly higher than those during BIPAP and autoflow. The three ventilation modes has no significant influence on expiratory phase of F-V curves. The linear regression analysis indicated that PEEPi was correlated with air trap （Vtrap） and expiratory flow rate at the end of expiratory. There was no difference among three ventilation modes in the slope of phase Ⅲ on CO2-time or volume curve, CO2 output, the amount of repeated CO2 inhalation, and the partial pressure of CO2 at the end of expiration. The dead space during autoflow and BIPAP was higher than that during IPPV. Peak during IPPV were greater than that during BIPAP and autoflow. The slope of phaseIU on CO2-volume curve was corelated with resistance, PEEPi and peak expiratory flow. Conclusion The ventilation modes can affect the shape of inspiratory phase but expiratory phase of the F-V curves. The three ventilation modes have no effect on CO2-time or volume curve. The dead space increases during autoflow and BIPAP.

关 键 词：肺病 慢性阻塞性 呼吸 人工 呼吸模式 

分 类 号：R536[医药卫生—内科学]