CAJ | 학술논문

目的监测慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭(RF)患者的内源性呼气末正压(PEEPi)并探讨处理方法.方法利用呼气末阻断法监测27例AECOPD合并RF机械通气患者的PEEPi,分别应用延长呼气时间,支气管扩张剂吸入,加用外源性呼气末正压(PEEPe),观察对总的呼气末正压(PEEPt)、气道峰压(Ppeak)、血流动力学及气体交换的影响.结果 27例AECOPD合并RF机械通气患者均存在不同程度的PEEPi,平均(7±4)cm H2O;延长呼气时间(调节吸气/呼气时间比为1:2.5)及给予支气管扩张剂(博利康尼)雾化吸人,PEEPi分别较前下降11.3%(P<0.05)和36%(P<0.01).加用≤75%PEEPi的PEEPe时,患者的PEEPt、Ppeak、心率、血压与基础值相比差异无统计学意义(P>0.05),但PaO2呈升高趋势,PaCO2呈降低趋势,且加75%PEEPi的PEEPe时,PaO2、PaCO2与基础PEEPi时相比差异有统计学意义(P<0.05),但当PEEPe增加至相当于100%PEEPi时,患者的PEEPt、Ppeak分别上升66.2%及37.9%,与基础值比较差异有统计学意义(P<0.01),且心率增加29.2%,血压下降9.7%,与基础值比较差异有统计学意义(P<0.05),PaO2、PaCO2与75%PEEPi时相比差异无统计学意义(P>0.05),说明给予较大PEEPe(>75%PEEPi)不仅增加气压伤的危险,且对血流动力学产生不利影响,对肺的气体交换也未优于较低水平(75%PEEPi)的PEEPe.结论 ①AECOPD合并RF机械通气患者普遍存在PEEPi;②通过延长呼气时间及予支气管扩张剂可明显减小PEEPi,改善气体交换;③外加≤75%PEEPi的呼气末正压可改善AECOPD合并呼吸衰竭患者的气体交换,对呼吸力学及血流动力学无显著影响.
목적 감측만성조새성폐질병급성가중기(AECOPD)합병호흡쇠갈(RF)환자적내원성호기말정압(PEEPi)병탐토처리방법.방법 이용호기말조단법감측27례AECOPD합병RF궤계통기환자적PEEPi,분별응용연장호기시간,지기관확장제흡입,가용외원성호기말정압(PEEPe),관찰대총적호기말정압(PEEPt)、기도봉압(Ppeak)、혈류동역학급기체교환적영향.결과 27례AECOPD합병RF궤계통기환자균존재불동정도적PEEPi,평균(7±4)cm H2O;연장호기시간(조절흡기/호기시간비위1:2.5)급급여지기관확장제(박리강니)무화흡인,PEEPi분별교전하강11.3%(P<0.05)화36%(P<0.01).가용≤75%PEEPi적PEEPe시,환자적PEEPt、Ppeak、심솔、혈압여기출치상비차이무통계학의의(P>0.05),단PaO2정승고추세,PaCO2정강저추세,차가75%PEEPi적PEEPe시,PaO2、PaCO2여기출PEEPi시상비차이유통계학의의(P<0.05),단당PEEPe증가지상당우100%PEEPi시,환자적PEEPt、Ppeak분별상승66.2%급37.9%,여기출치비교차이유통계학의의(P<0.01),차심솔증가29.2%,혈압하강9.7%,여기출치비교차이유통계학의의(P<0.05),PaO2、PaCO2여75%PEEPi시상비차이무통계학의의(P>0.05),설명급여교대PEEPe(>75%PEEPi)불부증가기압상적위험,차대혈류동역학산생불리영향,대폐적기체교환야미우우교저수평(75%PEEPi)적PEEPe.결론 ①AECOPD합병RF궤계통기환자보편존재PEEPi;②통과연장호기시간급여지기관확장제가명현감소PEEPi,개선기체교환;③외가≤75%PEEPi적호기말정압가개선AECOPD합병호흡쇠갈환자적기체교환,대호흡역학급혈류동역학무현저영향.
Objective To monitor and treat intrinsic positive end -expiratory pressure (PEEPi) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure (RF) during mechanicalventilation. Methods End-expiratory airway occlusion technique was used to measure the level of PEEPi in 27 patients with AECOPD and RF during mechanicalventilation. Extending expiratory time,inhalating bronchial dilator, using PEEPe were applied to observe their effects on total PEEP(PEEPt), peak airway pressure(Ppeak), hemodynamics, and gas exchange. Results The levers of PEEPi in 27 patiens with AECOPD during mechanic ventilation were (7±4)era H2O. Changed I: E to 1:2.5 and inhaled bronchial dilator,the PEEPi declined significantly by 11.3% (P<0.05) and 36% (P<0.01). Using PEEPe (≤75% PEEPi), had no effects on PEEPt, Ppeak and hemedynamics (P>0.05), PaO2 increased and PaCO2 decreased, when PEEPe equal 75% PEEPi, PaO2 increased significantly and PaCO2 decreased significantly(P<0.05). But when PEEPe increased 100% PEEPi, PEEPt and Ppeak increased significantly by 66.2% and 37.9% (P<0.01), heart rates increased significantly 29.2%(P<0.05), blood pressure decreased significantly 9.7% (P<0.05). PaO2 and PaCO2 had no significant different with the date when PEEPe equal 75% PEEPi. So bigger PEEPe (>75% PEEPi)inereased the danger of barotraumas and had adverse effects onhemedynamies, also had no advantage in lung's gas exchange. Conclusion ①It was common that PEEPi existed in patients with AECOPD and RF during mechanical ventilation.②Extending expiratory time and inhalating bronchial dilator may significantly decrease PEEPi and improve gas exchange. ③Low PEEPe(≤75% PEEPi)may improve the gas exchange,in the meanwhile may not affect respiratory dynamics and hemodynamics.