有机磷中毒患者呼吸肌力和中枢驱动的变化以及在机械通气脱机中的意义

Changes of central drive and power of respiratory muscles in patients with organophosphate poisoning and its significance in taking away mechanical ventilation

目的研究有机磷中毒患者呼吸肌力和中枢驱动的变化以及在机械通气脱机中的意义。方法12例有机磷中毒患者于机械通气脱机前分别测量PaO2、PaCO2、PH、P0.1、MIP、VT、CHE等指标,12例正常人也测量PaO2、PaCO2、PH、P0.1、MIP等指标。中毒组与正常组间用t检验,P0.1、MIP、VT与PaO2间相关分析用线性回归。结果有机磷中毒病人脱机前其MIP、P0.1和PaO2与正常人相比有显著差异性(P<0.01),有机磷中毒病人脱机前其MIP、P0.1和PaO2相比具有相关性(r=0.633和r=-0.649),VT和PaO2相比具有相关趋势。结论由于有机磷中毒病人的低氧和酸中毒兴奋呼吸中枢,故P0.1明显高于正常人群;有机磷中毒患者存在吸气肌疲劳,故MIP明显低于正常人群;P0.1和MIP和作为一种机械通气脱机的指标,与常用的PaO2、f等指标相比具有相关性;CHE活力在脱机过程中也起着十分重要性的作用。

[Objective] To study the changes of central drive and power of respiratory muscles in patients with organophosphate poisoning and the significance in taking away mechanical ventilation, [Methods] Before taking away mechanical ventilation in 12 patients with organophosphate poisoning, we determined the PaO2, PaCO2, pH, P0.1, MIP, VT, and CHE separately, Meanwhile, the PaO2, PaCO2, pH, P0.1, MIP were also determined in 12 healthy people. The t test was used to compare the indexes between the poisoning group and the healthy group. The relative relationship between P0.1, MIP, Vv and PaO2 was analyzed by using linear regression. [Results] The MIP, P0.1 and PaO2 in patients before taking away mechanical ventilation were significantly different with those in healthy people （P 〈0.01）. The MIP, P0.1, and PaO2 in patients before taking away mechanical ventilation were related with each other （r=0.633 和r=-0.649）. The VT had correlation trend with the PaO2. [Conclusion] （1） The hypoxia and acid poisoning in patients with organophosphate poisoning could excite the respiratory central. Therefore, the P0.1 in the patients was higher than that in healthy people. （2） The patients with organophosphate poisoning had muscular fatigue in inspiratory muscles. Therefore, they have significantly lower MIP than healthy people. （3） As usual indexes for taking away mechanical ventilation, the P0.1 and MIP were related with PaO2 arid f. （4） The activity of CHE was also very important in evaluation of taking away mechanical ventilation.