中华生物医学工程杂志
中華生物醫學工程雜誌
중화생물의학공정잡지
CHINESE JOURNAL OF BIOMEDICAL ENGINEERING
2011年
3期
264-268
,共5页
徐远达%黎锐发%罗远明%许继平%李宪玉
徐遠達%黎銳髮%囉遠明%許繼平%李憲玉
서원체%려예발%라원명%허계평%리헌옥
肺疾病,慢性阻塞性%肺通气%体位%潮气量%呼吸频率
肺疾病,慢性阻塞性%肺通氣%體位%潮氣量%呼吸頻率
폐질병,만성조새성%폐통기%체위%조기량%호흡빈솔
Pulmonary disease,chronic obstructive%Pulmonary ventilation%Posture%Tidal volume%Breathing frequency
探讨同步悬空俯卧位对稳定期慢性阻塞性肺疾病(COPD)患者肺通气功能情况的影响。方法 2009年6月至10月本院门诊就诊的12例稳定期COPD患者,在人工呼吸床上随机采用仰卧位、悬空俯卧位、托平俯卧位、同步悬空俯卧位4种不同体位,每个体位观察10 min,通过NICO无创心肺功能监测系统连续测定患者在不同体位时的心率、动脉血氧饱和度、呼气末二氧化碳分压等一般生命体征和呼吸频率、潮气量、肺泡潮气量、生理无效腔(Vd/Vt)、吸气峰流速(PIF)、呼气峰流速(PEF)等呼吸动力学指标。根据患者的肺功能按美国胸科协会(ATS)和欧洲呼吸学会(ERS)制定的肺功能共同指南标准划分不同阻塞程度,并分析存在通气功能障碍患者的潮气量和呼吸频率等肺功能变化情况。结果 4种体位对心率、动脉血氧饱和度、呼气末二氧化碳分压无明显的影响。呼吸频率在4种体位中由慢至快呈现同步悬空俯卧位＜仰卧位＜托平俯卧位＜悬空俯卧位的趋势[(14.8±3.2)次/min＜(17.6±4.5)次/min ＜(18.4±3.4)次/min＜(19.5±3.4)次/min,均P＜0.05],潮气量和肺泡潮气量由高至低呈现同步悬空俯卧位＞仰卧位＞托平俯卧位＞悬空俯卧位的趋势。生理无效腔、PIF、PEF各组差异无统计学意义。3例重度和5例极重度阻塞通气功能障碍的患者潮气量在各体位间差异均无统计学意义,呼吸频率则在同步悬空俯卧位时最低,分别为(15.3±1.8)次/min、(16.6±1.8)次/min,且与悬空俯卧位时的呼吸频率差异有统计学意义[(19.4±3.4)次/min、(21.4±3.6)次/min,均P＜0.05]。结论 同步悬空俯卧位与其他两种俯卧呼吸体位一样,经短时间观察是安全稳定的,同步悬空俯卧位显著降低患者的呼吸频率、增加潮气量。在阻塞性通气功能障碍的情况下,对潮气量的影响不明显,但仍能降低患者的呼吸频率。
探討同步懸空俯臥位對穩定期慢性阻塞性肺疾病(COPD)患者肺通氣功能情況的影響。方法 2009年6月至10月本院門診就診的12例穩定期COPD患者,在人工呼吸床上隨機採用仰臥位、懸空俯臥位、託平俯臥位、同步懸空俯臥位4種不同體位,每箇體位觀察10 min,通過NICO無創心肺功能鑑測繫統連續測定患者在不同體位時的心率、動脈血氧飽和度、呼氣末二氧化碳分壓等一般生命體徵和呼吸頻率、潮氣量、肺泡潮氣量、生理無效腔(Vd/Vt)、吸氣峰流速(PIF)、呼氣峰流速(PEF)等呼吸動力學指標。根據患者的肺功能按美國胸科協會(ATS)和歐洲呼吸學會(ERS)製定的肺功能共同指南標準劃分不同阻塞程度,併分析存在通氣功能障礙患者的潮氣量和呼吸頻率等肺功能變化情況。結果 4種體位對心率、動脈血氧飽和度、呼氣末二氧化碳分壓無明顯的影響。呼吸頻率在4種體位中由慢至快呈現同步懸空俯臥位＜仰臥位＜託平俯臥位＜懸空俯臥位的趨勢[(14.8±3.2)次/min＜(17.6±4.5)次/min ＜(18.4±3.4)次/min＜(19.5±3.4)次/min,均P＜0.05],潮氣量和肺泡潮氣量由高至低呈現同步懸空俯臥位＞仰臥位＞託平俯臥位＞懸空俯臥位的趨勢。生理無效腔、PIF、PEF各組差異無統計學意義。3例重度和5例極重度阻塞通氣功能障礙的患者潮氣量在各體位間差異均無統計學意義,呼吸頻率則在同步懸空俯臥位時最低,分彆為(15.3±1.8)次/min、(16.6±1.8)次/min,且與懸空俯臥位時的呼吸頻率差異有統計學意義[(19.4±3.4)次/min、(21.4±3.6)次/min,均P＜0.05]。結論 同步懸空俯臥位與其他兩種俯臥呼吸體位一樣,經短時間觀察是安全穩定的,同步懸空俯臥位顯著降低患者的呼吸頻率、增加潮氣量。在阻塞性通氣功能障礙的情況下,對潮氣量的影響不明顯,但仍能降低患者的呼吸頻率。
탐토동보현공부와위대은정기만성조새성폐질병(COPD)환자폐통기공능정황적영향。방법 2009년6월지10월본원문진취진적12례은정기COPD환자,재인공호흡상상수궤채용앙와위、현공부와위、탁평부와위、동보현공부와위4충불동체위,매개체위관찰10 min,통과NICO무창심폐공능감측계통련속측정환자재불동체위시적심솔、동맥혈양포화도、호기말이양화탄분압등일반생명체정화호흡빈솔、조기량、폐포조기량、생리무효강(Vd/Vt)、흡기봉류속(PIF)、호기봉류속(PEF)등호흡동역학지표。근거환자적폐공능안미국흉과협회(ATS)화구주호흡학회(ERS)제정적폐공능공동지남표준화분불동조새정도,병분석존재통기공능장애환자적조기량화호흡빈솔등폐공능변화정황。결과 4충체위대심솔、동맥혈양포화도、호기말이양화탄분압무명현적영향。호흡빈솔재4충체위중유만지쾌정현동보현공부와위＜앙와위＜탁평부와위＜현공부와위적추세[(14.8±3.2)차/min＜(17.6±4.5)차/min ＜(18.4±3.4)차/min＜(19.5±3.4)차/min,균P＜0.05],조기량화폐포조기량유고지저정현동보현공부와위＞앙와위＞탁평부와위＞현공부와위적추세。생리무효강、PIF、PEF각조차이무통계학의의。3례중도화5례겁중도조새통기공능장애적환자조기량재각체위간차이균무통계학의의,호흡빈솔칙재동보현공부와위시최저,분별위(15.3±1.8)차/min、(16.6±1.8)차/min,차여현공부와위시적호흡빈솔차이유통계학의의[(19.4±3.4)차/min、(21.4±3.6)차/min,균P＜0.05]。결론 동보현공부와위여기타량충부와호흡체위일양,경단시간관찰시안전은정적,동보현공부와위현저강저환자적호흡빈솔、증가조기량。재조새성통기공능장애적정황하,대조기량적영향불명현,단잉능강저환자적호흡빈솔。
Objective To investigate the impact of pulmonary ventilatory function of patients with stable chronic obstructive pulmonary disease (COPD) on simultaneous suspended prone position. Methods Twelve patients with stable COPD, who visited our clinic between June and October of 2009, were recruited in a series of assessments on a ventilation table using the supine position, suspended prone position, flat prone position and simultaneous suspended prone position in a randomized order, each position lasting 10minutes. Non-invasive NICO cardiopulmonary monitoring system was used for continuous recording of vital signs (heart rate, arterial oxygen saturation, end- tidal pressure of CO2) and respiratory mechanical parameters [respiratory rate, tidal volume, tidal volume of alveolus, physiological dead space(Vd/Vt), peak inspiratory flow (PIF) and peak expiratory flow (PEF)]with each position. The patients were stratified by severity of airway obstruction based on ATS-ERS pulmonary function standards guidelines. Moreover, the changes in pulmonary function (such as tidal volume and respiratory rate) in patients with ventilatory dysfunction were analyzed. Results The four types of patient positioning did not obviously affect heart rate,arterial oxygen saturation and end-tidal pressure of CO2. Respiratory rate in the 4 positions varied following the sequence of simultaneous suspended prone position ＜ supine position ＜ flat prone position ＜ suspended prone position [( 14.8±3.2)/min ＜ ( 17.6±4.5)/min ＜ ( 18.4±3.4)/min ＜ ( 19.5±3.4)/min; all P＜0.05]. Tidal volume and that of alveolus varied following the sequence of simultaneous suspended prone position ＞ supine position ＞ flat prone position ＞ suspended prone position. There were no statistical differences in physiological dead space, PIF and PEF among groups. In 3 severe and 5 extremely severe cases with obstructive ventilatory dysfunction, the tidal volume did not vary significantly among these 4 positions, while the respiratory rate was lowest in simultaneous suspended prone position [(15.3± 1.8)/min in severe cases and (16.6± 1.8)/min in extremely severe cases]as compared to that in suspended prone position [(19.4±3.4)/min in severe cases and (21.4±3.6)/min in extremely severe cases, all P＜0.05]. Conclusions As with other types of prone positioning, simultaneous suspended prone position is safe and stable within the shortterm period, but may reduce respiratory rate and increase the tidal volume significantly. In patients with obstructive ventilatory impairment, simultaneous suspended prone position may have no conspicuous impacts on tidal volume but remain effective in reducing the respiratory rate.
