慢性阻塞性肺疾病患者无创通气时吸氧方式对氧分压及二氧化碳分压的影响  

Effect of oxygen tubing connection site on percutaneous oxygen partial pressure and percutaneous carbon dioxide partial pressure in patients with chronic obstructive pulmonary disease during noninvasive positive pressure ventilation

作　　者：米崧[1] 张黎明[1] 

机构地区：[1]首都医科大学附属北京朝阳医院北京呼吸疾病研究所,100043

出　　处：《中华结核和呼吸杂志》2017年第4期267-271,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的评估无创正压通气（NPPV）时经面罩内鼻导管给氧及普通面罩给氧对慢性阻塞性肺疾病（慢阻肺）患者氧分压及二氧化碳分压的影响。方法前瞻性纳入北京朝阳医院2012年9月至2013年2月常规进行无创正压通气的9例慢阻肺合并Ⅱ型呼吸衰竭患者，其中男4例，平均年龄（59±6）岁；女5例，平均年龄（64±8）岁，同期纳入本科室无慢性心肺疾病史的10名医务人员作为健康志愿者，其中男4名，年龄平均（26±4）岁；女6名，年龄平均（30±5）岁。分别给予NPPV，经面罩内鼻导管给氧及经面罩给氧（氧流量为3和5L／min），测定经皮氧分压（PcO2）和经皮二氧化碳分压（PcCO2），评估无创通气时经面罩内鼻导管给氧及经面罩给氧对受试者PcO2、PcCO2的影响，从而间接反映经面罩内鼻导管给氧及经面罩给氧对吸入氧浓度的影响。结果健康志愿者[（154±22）mmHg（1mmHg=0．133kPa）]和慢阻肺患者[（80±18）mmHg]NPPV时经面罩内鼻导管给氧PcO2均明显升高，与经面罩给氧[（123±19）、（73±17）mmHg]相比差异有统计学意义（P〈0．05），提示经面罩内鼻导管给氧可提高吸入氧浓度。采用两种给氧方式时健康志愿者和慢阻肺患者PcCO2均无明显改变（P〉0．05）。结论NPPV时采用经面罩内鼻导管给氧的方式可提高吸入氧浓度进而提高PcO2，且不增高PcCO2，能够节约氧气，适应家庭NPPV，为开发经面罩内鼻导管给氧的新型无创通气面罩提供了理论基础。Objective We evaluated the effects of administering oxygen through nasal catheters inside the mask or through the mask on percutaneous oxygen partial pressure （PcO2 ）and percutaneous carbon dioxide partial pressure （PcCO2 ） during noninvasive positive pressure ventilation （NPPV） to find a better way of administering oxygen, which could increase PcO2 by increasing the inspired oxygen concentration. Methods Ten healthy volunteers and 9 patients with chronic obstructive pulmonary disease complicated by type Ⅱ respiratory failure were included in this study. Oxygen was administered through a nasal catheter inside the mask or through the mask （oxygen flow was 3 and 5 L/min） during NPPV. PcO2 and PcCO2 were measured to evaluate the effects of administering oxygen through a nasal catheter inside the mask or through the mask, indirectly reflecting the effects of administering oxygen through nasal catheter inside the mask or through the mask on inspired oxygen concentration. Results Compared to administering oxygen through the mask during NPPV, elevated PcO2 was measured in administering oxygen through the nasal catheter inside the mask, and the differences were statistically significant （ P 〈 0. 05 ）. At the same time, there was no significant change in PeCO2 （ P 〉 0. 05 ）. Conclusion Administering oxygen through a nasal catheter inside the mask during NPPV increased PcO2 by increasing the inspired oxygen concentration but did not increase PcCO2. This method of administering oxygen could conserve oxygen and be suitable for family NPPV. Our results also provided theoretical basis for the development of new masks.

关 键 词：机械通气 血气监测 经皮 

分 类 号：R563.9[医药卫生—呼吸系统]