不同有创机械通气模式对慢性阻塞性肺疾病合并呼吸衰竭患者睡眠质量及血流动力学的影响  

Effects of Different Invasive Mechanical Ventilation Modes on Sleep Quality and Hemodynamics in Respiratory Failure Complicated with Chronic Obstructive Pulmonary Disease Patients

作　　者：朱浩 ZHU Hao(Nantong First People′s Hospital,ICU,Nantong 226000,China)

机构地区：[1]江苏省南通市第一人民医院重症医学科,南通226000

出　　处：《世界睡眠医学杂志》2023年第9期1998-2000,共3页World Journal of Sleep Medicine

摘　　要：目的:观察不同有创机械通气模式对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者睡眠质量及血流动力学影响。方法:选取2020年9月至2022年12月江苏省南通市第一人民医院重症医学科及呼吸科慢性阻塞性肺疾病合并呼吸衰竭患者48例作为研究对象,按照随机数字表法分为对照组与观察组,对照组24例采用双水平正压通气模式(BIPAP),观察组24例采用压力支持通气模式(PSV)。比较2组治疗后睡眠质量[匹兹堡睡眠质量指数(PSQI)评分]及血流动力学参数[心率(HR)、中心静脉压(CVP)、心脏排血指数(CI)、全身血管阻力指数(SVRI)、全心舒张末容积(GEDI)]变化。结果:2组睡眠质量评分均显著下降,观察组较对照组下降更明显(P<0.05)。2组患者血流动力学指标在使用呼吸机前差异无统计学意义(P>0.05);采用不同呼吸机通气模式治疗后,2组CI、GEDI较治疗前下降,CVP较治疗前提升(P<0.05),且观察组治疗后较对照组改善显著(P<0.05),2组HR、SVRI治疗前组内比较及治疗后组间比较差异均无统计学意义(均P>0.05)。结论:PSV相对于BIPAP,有助于改善患者睡眠质量,且对血流动力学影响小。Objective:To compare the effects of different invasive mechanical ventilation modes on sleep quality and hemodynamics in respiratory failure complicated with chronic obstructive pulmonary disease patients.Methods:A total of 48 respiratory failure complicated with chronic obstructive pulmonary disease patients admitted to department of Critical Care Medicine,Nantong First People′s Hospital,Jiangsu Province from September 2020 to December 2022 were randomly selected and divided into control group and observation group with 24 patients in each group.The control group was given the mode of Bi-level positive pressure ventilation(BIPAP)and the observation group was given pressure supported ventilation mode(PSV).Sleep quality[Pittsburgh sleep quality index(PSQI)]and hemodynamic parameters:heart rate(HR),central venous pressure(CVP),cardiac output index(CI),systemic vascular resistance index(SVRI),global end-diastolic volume(GEDI)were compared between the two groups after treatment.Results:The total score of sleep quality in both groups decreased significantly,there were statistical differences between the two groups(P<0.05).Before using ventilator,there were no statistically significant differences in hemodynamic indexes between the two groups(P>0.05);after treatment,CI and GEDI in the two groups were lower than those before treatment,and CVP was higher than that before treatment,and the differences were statistically significant(P<0.05),compared with the observation group after treatment,there were statistically significant differences(P<0.05),while HR and SVRI didn′t have such significant differences before and after treatment(P>0.05).Conclusion:Compared with pressure assisted ventilation(PSV),bi-level positive pressure ventilation(BIPAP)are helpful to improve the sleep quality of patients,and has little effect on hemodynamics.

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 有创机械通气 睡眠质量 血流动力学 

分 类 号：R563[医药卫生—呼吸系统] R563.8[医药卫生—内科学] R338.63[医药卫生—临床医学] R356.3