双水平无创气道正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭膈肌疲劳的研究

Effects of bi-level positive airway pressure ventilation on muscular fatigue of diaphragm and respiratory failure in acute exacerbation of chronic obstructive pulmonary disease

目的 探讨双水平无创气道正压（BiPAP）通气治疗对慢性阻塞性肺疾病（COPD）急性加重期呼吸衰竭病人膈肌疲劳的恢复作用。方法 选择2003年9月-2005年8月住院的65例COPD急性加重期呼吸衰竭病人，按对照组与治疗组1：2的比例随机分为对照组23例、治疗组42例。对照组采用常规医疗干预，治疗组在对照组的基础上加用BiPAP通气治疗，并分别于治疗前和治疗后第7d进行膈肌肌电图检查，测定膈神经传导时间（PNCT）及动作电位（AP）幅度。结果 对照组PNCT治疗前后差异均无统计学意义[左：（8．130±0．710）ms比（8．270±0．410）ms；右：（8．072±0．690）ms比（8．350±0．390）ms，P均〉0．05]；AP幅度治疗前后差异有统计学意义[左：（0．414±0．141）mV比（0．590±0．140）mV；右：（0．414±0．135）mV比（0．550±0．170）mV，P均〈0．01]。治疗组PNCT治疗前后差异均有统计学意义[左：（7．991±0．560）ms比（7．664±0．509）ms；右：（8．041±0．590）ms比（7．719±0．520）ms，P均〈0．01]；AP幅度治疗前后差异有统计学意义[左：（0．405±0．165）mV比（0．613±0．164）mV，右：（0．388±0．170）mV比（0．599±0．171）mV，P均〈0．01]。两组治疗前PNCT及AP幅度无显著差异（P均〉0．05），治疗后PNCT有显著差异（P均〈0．01），AP幅度差异无统计学意义（P均〉0．05）。结论 BiPAP通气治疗可以改善COPD急性加重期呼吸衰竭病人的膈神经传导速度，而常规医疗干预仅能提高膈肌的动作电位幅度。

Objective To evaluate the effects of hi-level positive airway pressure （BiPAP） ventilation on muscular fatigue of diaphragm and respiratory failure in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods Sixty-five inpatients with AECOPD from Sep 2003 to Aug 2005 were enrolled in the study.Tbe subjects were randomly divided into control group （23 cases） and ventialtion group （42 cases） in 1 ： 2 proportion. Both groups were given the routine therapy and the ventilation group was given BiPAP ventilation. Diaphragm electromyogram was conducted in all cases to measure the phrenic nerve conduction time （PNCT） and the swing of action potential （AP） before and 7 days after treatment. Results The PNCTs in control group had no significant differences before and after treatment [ （8.130 ± 0.710）ms vs （8.270 ± 0.410） ms on the left and （8.072 ± 0.690） ms vs （ 8.350 ± 0.390） ms on the fight, both P 〉 0.05 ]. The APs in control group had significant differences before and after treatment[ （0.414 ± 0.141）mV vs （0.590 ± 0.140）mV on the left and （0.414 ± 0.135） mV vs （0.550 ± 0.170） mV on the right, both P 〈 0.01 ]. The PNCTs in the ventialtion group had significant differences before and after BiPAP treatment （7.991 ± 0.560）ms vs （7.664 ± 0.509）ms on the left and （8.041 ± 0.590）ms vs （7.719 ± 0.520）ms on the right,both P 〈0.01].The APs in the ventilation group had significant differences before and after treatment [（0.405 ± 0.165）mV vs （0.613 ± 0.164）mV on the left and （0.388 ± 0.170）mV vs （0.599 ± 0. 171 ）mV on the right, both P 〈 0.01 ]. There were no significant differences in the PNCTs and APs between both groups at baseline （ both P 〉 0.05）. After the treatment PNCTs were different significantly （ P 〈 0.01 ） and APs were not different significantly between two groups （ P 〉 0.05）. Conclusion BiPAP ventilation can improve conductive speed of phrenic nerve in patients with AECOPD while the routine treatment only increases the swing of action potential.