国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2010年
21期
1287-1289
,共3页
杜秀芳%黄平%洪永忠%钟春%张野%陈延伟%宋冰
杜秀芳%黃平%洪永忠%鐘春%張野%陳延偉%宋冰
두수방%황평%홍영충%종춘%장야%진연위%송빙
慢性阻塞性肺疾病%呼吸动力%无创正压通气%清醒
慢性阻塞性肺疾病%呼吸動力%無創正壓通氣%清醒
만성조새성폐질병%호흡동력%무창정압통기%청성
Chronic obstructive pulmonary disease%Respiratory dynamics%Noninvasive positive pressure ventilation%Wake
目的 探讨无创正压通气(NIPPV)对清醒状态慢性阻塞性肺疾病(COPD)患者呼吸动力的影响.方法 选择19例COPD急性加重期住院患者,治疗后病情稳定,通过食道-胃囊管法,检测气道开口压、食道压和胃内压,层流速仪测呼吸流速和容量改变.监测患者在清醒状态下自主呼吸及NIPPV时呼吸动力的变化.结果 ①对呼吸流速和肺通气的影响:吸气峰流速(PIF)、平均吸气流速(VT/Ti)、潮气量(VT)、分钟通气量(VE)在自主呼吸及NIPPV时,两组间变化差异无统计学意义.②对上气道阻力(Rua)和动态肺顺应性(CLdyn)的影响:自主呼吸时Rua(15.07±3.62)cm H2O·L-1·s-1、CLdyn(0.052±0.012)L/cm H2O,与自主呼吸比较,NIPPV时Rua减少6.91%(P＞0.05)、CLdyn增加44.23%(P＞0.05).③对呼吸肌肉活动和呼吸努力的影响:自主呼吸时跨膈压(Pdi)(19.85±4.00)cm H2O、食道负压(Pes)(-13.37±3.77)cm H2O,压力时间乘积(PTP)(287.79±95.14)cm H2O·s/min,与自主呼吸比较,NIPPV时Pdi下降61.96%(P＜0.001),Pes负压减少67.83%(P＜0.001),PTP下降58.80%(P＜0.01).结论 NIPPV对清醒状态COPD患者吸气流速、肺通气量及上气道阻力无明显影响;NIPPV有效的降低了呼吸肌肉活动,减少呼吸努力,改善呼吸肌疲劳.
目的 探討無創正壓通氣(NIPPV)對清醒狀態慢性阻塞性肺疾病(COPD)患者呼吸動力的影響.方法 選擇19例COPD急性加重期住院患者,治療後病情穩定,通過食道-胃囊管法,檢測氣道開口壓、食道壓和胃內壓,層流速儀測呼吸流速和容量改變.鑑測患者在清醒狀態下自主呼吸及NIPPV時呼吸動力的變化.結果 ①對呼吸流速和肺通氣的影響:吸氣峰流速(PIF)、平均吸氣流速(VT/Ti)、潮氣量(VT)、分鐘通氣量(VE)在自主呼吸及NIPPV時,兩組間變化差異無統計學意義.②對上氣道阻力(Rua)和動態肺順應性(CLdyn)的影響:自主呼吸時Rua(15.07±3.62)cm H2O·L-1·s-1、CLdyn(0.052±0.012)L/cm H2O,與自主呼吸比較,NIPPV時Rua減少6.91%(P＞0.05)、CLdyn增加44.23%(P＞0.05).③對呼吸肌肉活動和呼吸努力的影響:自主呼吸時跨膈壓(Pdi)(19.85±4.00)cm H2O、食道負壓(Pes)(-13.37±3.77)cm H2O,壓力時間乘積(PTP)(287.79±95.14)cm H2O·s/min,與自主呼吸比較,NIPPV時Pdi下降61.96%(P＜0.001),Pes負壓減少67.83%(P＜0.001),PTP下降58.80%(P＜0.01).結論 NIPPV對清醒狀態COPD患者吸氣流速、肺通氣量及上氣道阻力無明顯影響;NIPPV有效的降低瞭呼吸肌肉活動,減少呼吸努力,改善呼吸肌疲勞.
목적 탐토무창정압통기(NIPPV)대청성상태만성조새성폐질병(COPD)환자호흡동력적영향.방법 선택19례COPD급성가중기주원환자,치료후병정은정,통과식도-위낭관법,검측기도개구압、식도압화위내압,층류속의측호흡류속화용량개변.감측환자재청성상태하자주호흡급NIPPV시호흡동력적변화.결과 ①대호흡류속화폐통기적영향:흡기봉류속(PIF)、평균흡기류속(VT/Ti)、조기량(VT)、분종통기량(VE)재자주호흡급NIPPV시,량조간변화차이무통계학의의.②대상기도조력(Rua)화동태폐순응성(CLdyn)적영향:자주호흡시Rua(15.07±3.62)cm H2O·L-1·s-1、CLdyn(0.052±0.012)L/cm H2O,여자주호흡비교,NIPPV시Rua감소6.91%(P＞0.05)、CLdyn증가44.23%(P＞0.05).③대호흡기육활동화호흡노력적영향:자주호흡시과격압(Pdi)(19.85±4.00)cm H2O、식도부압(Pes)(-13.37±3.77)cm H2O,압력시간승적(PTP)(287.79±95.14)cm H2O·s/min,여자주호흡비교,NIPPV시Pdi하강61.96%(P＜0.001),Pes부압감소67.83%(P＜0.001),PTP하강58.80%(P＜0.01).결론 NIPPV대청성상태COPD환자흡기류속、폐통기량급상기도조력무명현영향;NIPPV유효적강저료호흡기육활동,감소호흡노력,개선호흡기피로.
Objective To investigate the effection on respiratory dynamics in noninvasive positive pressure ventilation (NIPPV) of chronic obstructive pulmonary disease (COPD)in wake. Methods Nineteen hospitalized COPD patients in relatively stable condition were recruited. Esophageal and gastric balloon-catheters were used for the detection of esophageal pressure and gastric pressure and airway opening pressure. Airflow and ventilation were measured with pneumotachograph. Each patient underwent a nocturnal polysomnogram. Data was collected from patients in spontaneous breathing and NIPPV in wake. Results There were no significant differences between the spontaneous breathing and NIPPV of PIF、VT/Ti、VT、VE、Rua and CLdyn with COPD in wake(all P ＞0. 05). The Pdi、Pes and PTP in NIPPV were significantly decresed compared with that of spontaneous breathing ( P ＜0. 05, or P ＜ 0. 001,respectively). Conclusions Studies shown NIPPV have no influence in airflow, ventilation and upper airway resistance with COPD in wake. NIPPV can reduce respiratory muscle activity and respiratory work, improve diaphragmatic fatigue.
