机械通气患者潮气呼吸肺功能检测的临床研究  

Analysis and evaluation on parameters of tidal breathing flow-volume curves in patients supported with mechanical ventilation

作　　者：陈宇清[1] 周新[1] 陈钦[1] 

机构地区：[1]上海交通大学附属第一人民医院呼吸科,上海200080

出　　处：《中国呼吸与危重监护杂志》2004年第3期163-166,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的　通过分析潮气呼吸流量 容积曲线 (TBFV)及其衍生参数 ,了解接受机械通气治疗的呼吸衰竭患者的气流阻塞程度 ,以及支气管扩张剂 (沙丁胺醇 )对TBFV各参数和呼吸力学特性的影响。方法　机械通气患者 2 6例 ,均为接受气管插管及机械通气 2 4h以上 ,基础疾病为慢性阻塞性肺疾病急性加重期 (AECOPD)和支气管哮喘重度发作。保持患者处于镇静状态 ,应用定容型同步间歇指令通气模式 (V SIMV) ,潮气量 (VT) 7～ 9ml/kg;采集 5次指令通气的TBFV数据 ,采用阻断法测定系统静态顺应性 (Cst)、气道阻力 (Raw)及内源性呼气末正压 (PEEPi)。吸入沙丁胺醇2 0min后重复测定上述各参数。结果　 2 6例患者吸入沙丁胺醇后Raw由 ( 2 1 9±2 4 )cmH2 O·L-1·s-1降至 ( 13 1± 1 8)cmH2 O·L-1·s-1,PEEPi自 ( 6 9± 1 2 )cmH2 O减少至 ( 4 5±1 1)cmH2 O ,与吸入前相比有显著性差异 (P均 <0 0 5 ) ,Cst无明显变化 [( 4 7 5± 4 2 )与 ( 5 0 2± 3 5 )ml/cmH2 O](P >0 0 5 )。TBFV参数中的达峰时间比 (TPTEF/TE)、TEF 5 0 /PTEF和TEF 2 5 /PTEF在吸入沙丁胺醇后呈显著增高 (P <0 0 5 ) ,PTEF和VPTEF/VTE仅轻度增高 (P >0 0 5 )。相关性分析显示除PTEF外 ,TBFV的其余各参数均与Raw和PEEPi显著相关 (P <0 0 5 )Objective To evaluate the severity of airflow obstruction in patients supported with mechanical ventilation and the effect of salbutamol inhalation on respiratory mechanics by analysis parameters of tidal breathing flow-volume curves (TBFV).Methods 26 patients (age 67±5) were intubated,sedated and mechanically ventilated at least 24 hour for acute respiratory failure resulted from different underlying disorders (chronic obstructive pulmonary disease and asthma).After 20 mins with volume controlled ventilation (SIMV mode,tidal volume 7～9 ml/kg),TBFV loops and respiratory mechanics[ compliance (Cst),airway resistance(Raw) and instrinic PEEP,(PEEPi)] were measured before and after salbutamol 600 μg inhalation.Results After salbutamol inhalation,in all patients Raw was decreased [(21.9±2.4) cm H 2O·L -1 ·s -1 versus (13.1±1.8) cm H 2O·L -1 ·s -1 ,P<0.05),and PEEPi was lower [ (6.9±1.2)cm H 2O versus (4.5±1.1)cm H 2O] significantly (P<0.05).Peak tidal expiratory flow (PTEF) and the fraction of exhaled volume to achieve PTEF to V TE (VPTEF/V TE ) were increased slightly,but the fraction of exhaled time to achieve PTEF to T E (TPTEF/T E),tidal expiratory flow at 50% of the remaining tidal volume/PTEF (TEF 50/PTEF) and tidal expiratory flow at 25% of the remaining tidal volume/PTEF (TEF 25/PTEF) were significant increased (P<0.05).TEF 50/PTEF,TEF 25/PTEF had a significant correlations with PEEPi (r=0.59 and 0.54,P<0.05) and the correlations became less significant after salbutamol inhalation.Conclusions The measurement of TBFV loops was a simple approach without requirement for special technique.The degree of airflow obstruction and the effect of bronchodilator drug in mechanical ventilated patients could be monitored by analysis of TBFV parameters.

关 键 词：机械通气 潮气呼吸 肺功能 检测 呼吸衰竭 气流阻塞 

分 类 号：R563.8[医药卫生—呼吸系统] R459.6[医药卫生—内科学]