压控下递增型呼气末正压在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者初始有创机械通气中的应用  

Clinical application of incremental PEEP under pressure control in initial invasive mechanical ventilation of patients with AECOPD combined with respiratory failure

作　　者：张辉[1] 李盼[1] 王笃杰[1] 王学军[1] 马盼盼 Zhang Hui;Li Pan;Wang Dujie;Wang Xuejun;Ma Panpan(Department of Critical Care Medicine, Binzhou Central Hospital, Binzhou 251700, China)

机构地区：[1]山东省滨州市中心医院重症医学科,251700

出　　处：《中国实用医刊》2019年第5期60-63,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨压控下递增型呼气末正压(PEEP)在慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者初始有创机械通气中的临床应用。方法选取2015年3月至2017年2月于滨州市中心医院行有创机械通气的78例AECOPD患者为研究对象,并按随机数字表法分为对照组(40例)和观察组(38例)。初始上机时对照组外源性PEEP(PEEPe)设为0.8内源性PEEP(0.8 PEEPi),观察组在0、1、2、3 h PEEPe分别设为0、2 cmH2O(1 cmH2O=0.098 kPa)、3 cmH2O、0.8 PEEPi。比较两组初始有创机械通气后1、2、3 h气道峰压(Ppeak)、平均气道压(Pmean)、呼出潮气量(Vte)、动脉氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、脉搏血氧饱和度(SpO2)及上机有效率。结果通后气1、2 h,观察组Ppeak、Pmean低于对照组,Vte高于对照组,差异有统计学意义(P<0.05);PaCO2、PaO2、SpO2与对照组比较,差异未见统计学意义(P>0.05)。通气后3 h,观察组Ppeak、Pmean、PaCO2低于对照组,Vte、PaO2、SpO2高于对照组,差异有统计学意义(P<0.05)。独立样本卡方检验显示,观察组上机有效率为86.8%(33/38),对照组为65.0%(26/40),差异有统计学意义(P=0.025)。结论递增型PEEP适合于AECOPD患者初始机械通气时。部分AECOPD患者初始上机时PEEP需设置为0。Objective To investigate the clinical application of incremental positive end expiratory pressure (PEEP) under pressure control in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)combined with respiratory failure in initial invasive mechanical ventilation. Methods Seventy-eight AECOPD patients who were given invasive mechanical ventilation in Binzhou Central Hospital from March 2015 to February 2017 were selected as research objects. And they were divided into control group (40 cases) and observation group (38 cases) by random number table method. The exogenous PEEP (PEEPe) of control group was set to 0.8 endogenous PEEP (0.8 PEEPi), while the parameters of observation group were set up to 0, 2 cmH2O (1 cmH2O=0.098 kPa), 3 cmH2O, and 0.8 PEEPi at 0, 1, 2 and 3 hours after invasive mechanical ventilation, respectively. The airway peak pressure (Ppeak), mean airway pressure (Pmean), exhaled tidal volume (Vte), arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), pulse oxygen saturation (SpO2) and upper machine efficiency were compared between the two groups 1, 2, and 3 hours after invasive mechanical ventilation. Results At 1 hour and 2 hours after ventilation, the Ppeak and Pmean in observation group were significantly lower than those in control group, and the Vte was significantly higher than that in control group (P<0.05);but there was no significant difference in PaCO2, PaO2, SpO2 between observation group and control group (P>0.05). At 3 hours after ventilation, Ppeak, Pmean and PaCO2 were significantly lower than those in control group, however, Vte, PaO2 and SpO2 were significantly higher than those in control group (P<0.05). The independent sample chi-square test showed that the effective rate in observation group was 86.8%(33/38), and it was 65.0%(26/40) in control group, and the difference was statistically significant (P=0.025). Conclusions The incremental PEEP is suitable for AECOPD patients with initial mechanical ventilation. Sometimes, the PEEP

关 键 词：慢性阻塞性肺疾病 呼气末正压 递增型 有创机械通气 

分 类 号：R563.9[医药卫生—呼吸系统] R563.8[医药卫生—内科学]