慢性阻塞性肺疾病无创通气期间高浓度吸氧对二氧化碳分压的影响  

Influence of High Fraction of Inspired Oxygen on PaCO_2 During Noninvasive Ventilation in Patients with Acute Exacerbation of COPD

作　　者：王金荣[1] 高攀[1] 郭淑芬[1] 刘亚晶[1] 刘淑红[1] 高秀玲[1] 崔朝勃[1] 

机构地区：[1]河北医科大学附属衡水哈励逊国际和平医院呼吸和危重症医学科,河北衡水053000

出　　处：《中国呼吸与危重监护杂志》2016年第4期329-332,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的观察二氧化碳潴留的慢性阻塞性肺疾病(简称慢阻肺)急性加重期患者于无创通气(NIV)期间高浓度吸氧的安全性。方法纳入2013年3月至2015年8月在哈励逊国际和平医院呼吸和危重症医学科住院的56例慢阻肺急性加重患者。慢阻肺急性加重患者经低吸氧浓度(FiO_2<0.5)NIV治疗病情稳定后,将FiO_2增加到1.0并持续40 min,观察试验前后潮气量、呼吸频率、分钟通气量、Glasgow评分、动脉血气分析和指氧饱和度(SpO_2)的变化。结果有二氧化碳潴留的慢阻肺急性加重患者在NIV期间经高FiO_2吸氧后,PaO_2由(83±14)mm Hg显著增加至(165±41)mm Hg(P<0.001);SpO_2由(92.4±3.1)%显著增加至(97.8±1.9)%(P<0.001);而PaCO_2试验前后分别为(72±15)mm Hg和(72±14)mm Hg,差异无统计学意义(P=0.438),潮气量、呼吸频率、分钟通气量、Glasgow评分等参数亦无明显变化(P>0.05)。结论慢阻肺急性加重患者NIV治疗期间,在病情稳定的基础上,短期增加FiO_2不会加重二氧化碳潴留。Objective To investigate the safety of high fraction of inspired oxygen（FiO2） during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD） and carbon dioxide（CO2） retention. Methods Fifty-six AECOPD patients with CO2 retention admitted between March 2013 and August 2015 were recruited in the study. All patients received noninvasive ventilation treatment with FiO2〈 0. 5. After stabilization of acute respiratory crisis,FiO2 was increased to 1. 0and lasted for 40 minutes. The changes of tidal volume,respiratory frequency,minute volume,Glasgow coma score,arterial blood gas and SpO2 were observed before and after the FiO2 reset. Results The mean PaO2 increased from（83 ± 14） mm Hg to（165 ± 41） mm Hg and the mean SpO2 increased from（92. 4 ± 3. 1） %to（97. 8 ± 1. 9） % significantly（ both P 〈 0. 001）. The mean Pa CO2 did not changed obviously from（72 ±15） mm Hg to（72 ± 14） mm Hg（ P = 0. 438）. There were also no significant changes in any of the other parameters. Conclusion During noninvasive ventilation with an FiO2 sufficient to maintain a normal PaO2,an increase in FiO2 does not further increase Pa CO2 level in AECOPD patients with CO2 retention.

关 键 词：慢性阻塞性肺疾病 急性加重 无创通气 吸氧浓度 二氧化碳潴留 

分 类 号：R563.9[医药卫生—呼吸系统]