外源性呼气末正压对慢性阻塞性肺疾病患者呼吸功的影响  

The effects of extrinsic positive end-expiratory pressure on work of breathing in patients with chronic obstructive pulmonary disease

作　　者：孔维民[1] 王辰[1] 杨媛华[1] 黄克武[1] 姜超美[1] 翁心植[1] 

机构地区：[1]首都医科大学附属北京朝阳医院北京市呼吸病研究所,100020

出　　处：《中华内科杂志》2001年第6期385-389,共5页Chinese Journal of Internal Medicine

摘　　要：目的　探讨外源性呼气末正压 (PEEPe)对慢性阻塞性肺疾病 (COPD)患者呼吸功的影响及其机制。方法　选择接受气管插管和机械通气的COPD患者 10例 ,使用BicoreCP 10 0呼吸力学监测仪进行呼吸力学监测。首先测定PEEPe为 0时的动态内源性呼气末正压 (PEEPi) ,再以此值的 0、40 %、6 0 %、80 %和 10 0 %随机设置PEEPe ;在每次改变PEEPe水平 30min后 ,测定呼吸力学及心率、血压、动脉血气。结果　患者的呼吸功、压力时间乘积、食管压差和动态PEEPi在加用PEEPe后即明显降低 ,且随着PEEPe的增加继续下降 (P值均 <0 0 1)。当PEEPe加至PEEPe =0时所测的动态PEEPi的 80 %和 10 0 %时 ,呼吸机做功显著增加 (P值均 <0 0 1)。呼吸功的变化和动态PEEPi的变化呈直线正相关关系 (r=0 6 0 9,P <0 0 1)。结论　PEEPe可降低呼吸功 。Objective To study the effect of extrinsic positive end expiratory pressure(PEEPe) on work of breathing in chronic obstructive pulmonary disease (COPD) patients and its mechanism. Methods 10 ventilated patients [4 males and 6 females with mean age of (70.1±5.5) years] with exacerbation of COPD were admitted into the study. All the patients′ cardiopulmonary functions were stable, and they could receive pressure support ventilation (PSV). Patients with sever heart dysfunction, hepatic dysfunction, renal dysfunction or fever were ruled out. Each patient had an esophagus balloon pressure sensor inserted, and the esophagus balloon was properly positioned using “occlusion test”. Flow sensor was placed at the end of tracheal tube opening. Then esophagus balloon pressure sensor and flow sensor were connected with Bicore CP 100 pulmonary monitor. Dynamic intrinsic positive end expiratory pressure (PEEPi,dyn), difference of esophagus pressure (dPes), work of breathing patient (WOBp), work of breathing ventilator (WOBv), pressure time product (PTP), tidal volume (Vt), respiratory rate (RR), minute ventilation (MV), peak inspiratory flow rate (PIFR), peak expiratory flow rate (PEFR), expiratory airway resistance (Rawe), fraction of inspiration (Ti/Ttot) and so on were measured. PEEPi,dyn was measured by esophagus balloon technique . Electrocardiogram and noninvasive blood pressure modes were added to HP M1165A monitor. Heart rate (HR) and blood pressure (BP) were also measured. Arterial blood was analyzed to measure pH, partial pressure of oxygen in arterial blood (PaO 2), partial pressure of carbon dioxide in arterial blood (PaCO 2) and saturation of arterial blood oxygen (SaO 2). At first, PEEPi,dyn was measured when PEEPe was zero, which was called PEEPi,dynz and was set as baseline. Then PEEPe was set randomly, which was 0%, 40%, 60%, 80% and 100% of PEEPi,dynz respectively. Other parameters remained stable. All the indexes were measured 30 minutes after the level of PEEPe was changed. Results WOBp decrea

关 键 词：阻塞性肺疾病 外源性呼气末正压 内源性呼气末正压 呼吸功 

分 类 号：R563.9[医药卫生—呼吸系统]