不同PEEP水平对AECOPD伴肺动脉高压患者O_(2)UC、血清炎性因子及脑血流灌注状态的影响对比  

Effects of different levels of PEEP on O2UC,serum inflammatory factors and cerebral blood flow perfusion in AECOPD patients with pulmonary hypertension

作　　者：任双双 杨冬梅 黄娟 Ren Shuang-shuang;Yang Dong-mei;Huang Juan(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 47100,Henan,China)

机构地区：[1]河南科技大学第一附属医院呼吸与危重症医学科,河南洛阳471003

出　　处：《四川生理科学杂志》2023年第8期1337-1340,共4页Sichuan Journal of Physiological Sciences

摘　　要：目的:探讨不同呼气末正压通气(Positive end expiratory pressure,PEEP)水平对慢性阻塞性肺疾病急性加重期(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴肺动脉高压患者的影响。方法:选取2020年6月至2022年5月期间我院收治的103例AECOPD伴肺动脉高压患者作为研究对象,所有患者按照随机数字表法分为常规组(n=51)和高水平组(n=52)。常规组采用常规PEEP,高水平组采用高水平PEEP,两组患者均持续治疗3 d。观察两组氧利用率、血清炎性因子、脑血流灌注以及肺功能。结果:治疗3 d后,高水平组氧利用率(Ratio of oxygen utilization,O_(2)UC)高于常规组(P<0.05);高水平组超敏C-反应蛋白(High sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白-细胞介素-6(Interleukin-6,IL-6)以及降钙素原(Procalcitonin,PCT)水平低于常规组(P<0.05);高水平组阻力指数(Resistance Index,RI)、搏动指数(Pulsatility index,PI)和平均血流速度(Mean velocity,Vm)和常规组无明显差异(P>0.05);高水平组肺用力肺活量占预计值百分比(Percentage of forced vital capacity to the expected value,FVC%pred)、第一秒用力呼气容积占预计值百分比(Percentage of forced expiratory volume in the first second to the expected value,FEV1%pred)、第一秒用力呼气容积占用力肺活量百分比(Percentage of forced expiratory volume in the first second to forced vital capacity,FEV1/FVC)均高于常规组(P<0.05)。结论:相比较于常规PEEP,将高水平PEEP用于AECOPD伴肺动脉高压患者中可提高氧利用率,促进肺功能恢复,减轻机体炎症反应,且不影响脑血流灌注。Objective:To explore different Positive end expiratory pressure(Positive end expiratory pressure,PEEP)exacerbation of Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with pulmonary hypertension.Methods:A total of 103 patients with AECOPD with pulmonary hypertension admitted to our hospital from June 2020 to May 2022 were selected as research objects.All patients were divided into the conventional group(n=51)and the high-level group(n=52)according to random number table.Regular PEEP was used in the conventional group and high level PEEP was used in the high level group.Both groups were treated for 3 days.Oxygen utilization,serum inflammatory factors,cerebral blood perfusion and lung function were observed in the two groups.Results:After 3 days of treatment,the ratio of oxygen utilization(O_(2)UC)in the high level group was higher than that in the conventional group(P<0.05).The levels of high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and procalcitonin(PCT)were lower than those in the conventional group(P<0.05).There was no significant difference in resistance index(RI),pulsatility index(PI)and mean blood flow velocity(Vm)between the high level group and the conventional group(P>0.05).Percentage of forced vital capacity to the expected value(FVC%pred),percentage of forced expiratory volume in the first second to the expected value(FEV1%pred),percentage of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC)were higher than those in the conventional group(P<0.05).Conclusions:Compared with conventional PEEP,the application of high-level PEEP in patients with AECOPD and pulmonary hypertension can improve oxygen utilization,promote lung function recovery,reduce inflammation,and do not affect cerebral blood perfusion.

关 键 词：呼气末正压通气 炎症因子 肺功能 脑血流灌注 

分 类 号：R743[医药卫生—神经病学与精神病学]