肺心病急性发作机械通气时内生性呼气末正压的处理

The treatment of intrinsic positive end-expiratory pressure in patients with Cor puhnonale

目的 探讨肺心病急性发作期机械通气时内生性呼气末正压(PEEPi)的处理方法。方法 利用呼气末阻断技术监测10例肺心病急性发作期机械通气患者PEEPi,分别应用延长呼气时间,支气管扩张剂吸入,外设3、6及9cm H_2O呼气末正压(PEEPe)方法,观察对PEEPi及相应气道峰压(PAP)、血流动力学及气体交换的影响。结果 10例肺心病急性发作期机械通气患者存在(6.8±2.1)cm H_2O PEEPi,将吸气:呼气时间(I:E)设置为1:2.5及予喘乐宁吸入后,PEEPi分别下降8.8％(P<0.05)及32％(P<0.01),PaO_2分别上升5％及7.5％(P<0.05),PaCO_2分别下降12.5％、6.5％(P<0.05),PAP及血流动力学指标无显著改变。分别予3、6及9cmH_2O PEEPe后,PaO_2分别上升5％、8.8％(P<0.05)及16.2％(P<0.01),在6、9cm H_2O PEEPe时PaCO_2下降8％(P<0.05)。PEEPe为9cm H_2O时,PEEPi上升58％(P<0.01),PAP升高13％(P<0.05),对血流动力学产生不良影响。结论 (1)肺心病急性发作期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PEEi,改善气体交换;(3)外设低水平PEEP可最大程度改善气体交换,对呼吸力学及血流动力学无显著影响。

Objective To investigate the treatment of intrinsic positive end-expiratory pressure in patients with Cor pulmonale during mechanical ventilation. Methods End-expiratory airway occlusion technique was used to measure the levers of PEEPi in 10 patients with Cor pulmonale during mechanical ventilation.Extending expiratory time,inhalating bronchial dilator,using 3,6,9 cm H2O PEEPe were applied to observe their effects on PEEPi, peak airway pressure (PAP), hemodynamics, and gas ex-charge. Results The levers of PEEPi in 10 pations with Cor pulmonale during mechanic ventilation were (6.812.1) cm H2O.Changed I: E to 1:2.5 and inhaled Ventolin.the PEEPi declined significantly by 8.8% (P<0.05)and 32%(P<0.01) ,but have no effects on PAP and hemodynamics.By application of 3,6,9 cmH2O PEEPe,PaO2 increased significantly by 5% ,8.8% (P<0.05) .and 16.2% (P<0.01). PaCA decreased by 8%(PEEPe = 6 and 9 cm H2O,P<0.05) .When applied 9 cm H2O PEEPe.PEEPi and PAP increased significantly by 58% and 13%(P<0.01) ,and had an adverse effect on hemodynamics. Conclusions 1. It was common that PEEPi existed in patients with Cor pulmonale during mechanic ventilation.2 .Extending expiratory time and inhalating bronchial dilator may significantly decrease PEEPi and improve gas exchange.3.Low PEEPe may improve the gas exchange,in the meanwhile may not affect PAP and hemodynamics.