氨茶碱对慢性阻塞性肺病患者跨膈压的影响

Influence of aminophylline injection on transdiphragmatic pressure of chronic obstructive pulmonary dis ease patients

目的 :评估吸氧及静脉应用氨茶碱对慢性阻塞性肺病 (COPD)患者的跨膈压 (Pdi)的影响。方法 :应用连续灌注导管测压系统 ,采用分段外曳法测定 1 9例 COPD患者平静呼吸时的 Pdi,在用力呼尽肺内气体行最大努力吸气时测最大跨膈压(Pdimax) ;于吸氧 (2 L/ m in) 30 min后以及静脉注射氨茶碱 30 min后分别测定 Pdi、Pdimax,并与 8例健康者进行对照。 结果 :COPD组 Pdi为 (4 1 .78± 2 1 .6 3) cm H2 O(1 cm H2 O =0 .0 98k Pa) ,Pdimax为 (5 2 .6 6± 2 2 .4 3) cm H2 O,对照组分别为 (1 0 2 .4 3±2 0 .6 7)和 (1 32 .35± 2 9.1 2 ) cm H2 O,两组间差异有显著性意义 (P<0 .0 1 )。COPD患者吸氧 30 min后 Pa O2 由 (6 2 .6 3± 1 1 .81 )mm Hg(1 m m Hg=0 .1 33k Pa)上升到 (87.6 3± 9.70 ) mm Hg,差异有显著性 (P<0 .0 1 ) ;同时 Pa CO2 下降 ,Pdi、Pdimax有不同程度增加 ,但吸氧前后的差异无显著性。 COPD患者静脉注射氨茶碱后 ,Pdi、Pdimax分别由 (4 2 .37± 1 8.33)、(5 3.76± 2 0 .5 7)cm H2 O上升到 (5 7.4 8± 2 3.39)、(73.94± 2 4 .86 ) cm H2 O,差异有显著性意义 (P<0 .0 1 )。 结论 :连续灌注导管测压系统是测定 Pdi的有效方法 ;氨茶碱可提高 COPD患者跨膈压 。

Objective:To compare the influence of oxygen inhalation and intravenous injection of aminophylline on trans-diphragmatic pressure(Pdi)in chronic obstructive pulmonary disease(COPD)patients.Methods:Nineteen COPD patients (15males and4females)and8healthy controls(6males and2females)were included in this study.By means of fractional extraction,the Pdi of19COPD patients under normal breath and Pdi-Max after the lung maximal exhalation and inhalation were measured by continuous perfusion manometric tube.The Pdi and Pdi-Max were measured30min after oxygen inhalation (2L/min)and30min after intravenous injection of aminophylline.The results were compared with those of control group.Results:Pdi and Pdi-Maxt were(41.78±21.63)cmH 2 O and(52.66±22.43)cmH 2 O in COPD patients and (102.43±20.67) cmH 2 O and(132.35±29.12)cmH 2 O in control group(1cmH 2 O=0.098kPa).There was significant difference between2groups(P<0.01).PaO 2 rose from(62.63±11.81)mmHg(1mmHg=0.133kPa)to(87.63±9.70)mmHg30min after oxygen inhalation(P<0.01).Meanwhile,PaCO 2 dropped,Pdi and Pdi-Max rose,but there was no significant difference com-pared with non-oxygen inhalation.After intravenous injection of aminophylline,Pdi and Pdi-Max rose from (42.37±18.33) cmH 2 O and(53.76±20.57)cmH 2 O to(57.48±23.39)cmH 2 O and(73.94±24.86)cmH 2 O,respectively(P<0.01).Con-clusion:Continuous perfusion manometric tube is an effective means for measuring Pdi of COPD patients.Amionphylline can increase Pdi and help alleviate diaphragmatic fatigue.