肺部物理治疗对急性呼吸衰竭患者呼吸系统顺应性的影响

Effect of Thoracic Physical Therapy on Respiratory Compliance in Acute Respiratory Failure Patients

目的研究单纯肺部物理治疗和叹气通气模式对急性呼吸衰竭患者呼吸力学与血流动力学的变化。方法选取ICU中21例镇静状态、无自主呼吸、依靠机械通气容量控制(CMV)模式维持呼吸功能的患者;采用自身前后对照对21例患者随机施行肺部物理治疗和叹气呼吸模式两种干预措施,肺部物理治疗采用机械法(美国产G5振肺机),双侧振肺时间分别为3min,振动频率为10r/s(1min)→20r/s(1min)→30r/s(1min);叹气呼吸模式通过调节潮气量来获取双倍基础潮气量,连续3个呼吸周期,然后将潮气量重新调整为基础水平。于每种干预措施后5min测量患者的呼吸力学参数和血流动力学参数。结果施行肺部物理治疗后呼吸系统顺应性(Cst)有改善(P<0.05),血氧饱和度(SaO2)增加(P<0.05),肺部物理治疗患者心率增快(P<0.05),对血压无影响(P>0.05);施行机械通气叹气模式后患者Cst降低(P<0·05),血氧饱和度(SaO2)无变化(P>0.05)。两种方法在改善Cst方面具显著性差异(Z=-3.638,P<0·0001)。结论肺部物理治疗在不增加潮气量和吸氧浓度的条件下可改善急性呼吸衰竭患者Cst,提高血氧饱和度;同时也会出现心率增快的负面效果。机械通气叹气模式使急性呼吸衰竭患者Cst降低,氧合无改善。因此,肺部物理疗法对改善急性呼吸衰竭患者Cst具有积极意义。

Objective To study the effect of physical therapy and sigh ventilation mode on respiratory mechanics and oxygenation in acute respiratory failure patients. Methods Twenty-one anesthetic controlled volume ventilated patients without spontaneous breathing were included in the present study. The patient received physical therapy and then sigh ventilation. The physical therapy was performed by a Shaking Machine （G5, U. S. ）, with increasing frequency from 10 r/s （1 min） to 20 r/s （1 min） and 30 r/s （1 min）. In sigh ventilation mode, the tidal volume was increased to double basic tidal volume and was decreased to the basic value after 3 respiratory cycles. The respiratory mechanic values and heamodynamic values were measured after 5 min intervention. Results After physical therapy, the respiratory compliance （Cst） was improved significantly （ P 〈0.05）, the oxygen saturation （SaO2） increased significantly （ P 〈0.05） ; the heart rate also increased （ P 〈0.05）, but the blood pressure remained unchanged. With sigh ventilation mode, Cst decreased（ P 〈0.05） and SaO2 remained unchanged. Physical therapy improved Cst more obviously than sigh ventilation mode did （ P 〈0. 0001）. Conclusion Under the condition of stable tidal volume and inspired oxygen concentration, physical therapy can improve Cst and SaO2 with increasing heart rate in acute respiratory failure patients, whereas sigh ventilation mode can decrease Cst and can not improve SaO2. Therefore, physical therapy may be beneficial in improving Cst in acute respiratory failure patients.