双相气道正压通气与双水平气道正压通气在慢性阻塞性肺疾病中呼吸动力学的比较研究

Comparison of biphasic positive airway pressure and Bi-level positive airway pressure on respiratory mechanics in patients with chronic obstructive pulmonary disease

目的 比较自主呼吸状态下，双相气道正压通气（BIPAP）与双水平气道正压通气BiPAP在慢性阻塞性肺疾病（COPD）患者中呼吸动力学方面的差异。方法 将9例达到入选标准气管插管，接受机械通气治疗的COPD患者，按随机顺序给予BIPAP（高压为16cmH2O，低压5cmH2O，高压时间和低压时间均为2秒）和BiPAP（吸气末正压16cmH2O，呼气末正压5cmH2O）两种模式通气，每种通气模式持续30min，于最后10min分别记录通气时的食道压变化值（△Peso）、跨膈压变化值（△Pdi）、食道压压力时间乘积（PTPeso）、跨膈压压力时间乘积（PTPdi）、气道闭合压（P0.1）、分钟通气量（VE）、潮气量（VT）、呼吸频率（RR）以及血气值。结果 与BiPAP通气时相比，BIPAP通气时的△Peso、△Pdi、P0.1、PEEPi、PTPeso、PTPdi均显著增高（P〈0.05），VE和VT明显降低（P〈0.05）。BiPAP通气时的PaO2和BIPAP通气时无显著性差异，但PaCO2后者明显高于前者（P〈0.05），RR两者无显著性差异。结论 在自主呼吸情况下，BiPAP对减少COPD患者呼吸肌的作功、改善通气显著优于BIPAP。

Objective To compare the respiratory mechanics of biphasic positive airway pressure （BIPAP） and Bi-level positive airway pressure （BiPAP） ventilatory modes in the patients with chronic obstructive pulmonary disease （COPD） in spontaneously breathing condition. Methods Nine intubated COPD patients receiving mechanical ventilation treatment, meeting the criteria of selection, were ventilated in randomized order with BIPAP （16 cm H2O Phigh and 5 cm H2O Plow） and Bi-level（IPAP 16 cm H2O and PEEP 5 cm H2O）for 30 min respectively. The change in esophageal pressure（△Peso）, transdiaphragmatic pressure （△Pdi）, pressure time product of esophageal pressure （PTPeso）, pressure time product of transdiaphragmatic pressure （ PTPdi）, mouth occlusion pressure （ P0.1 ）, intrinsic PEEP （ PEEPi）, respiratory frequency（RR） ,tidal volume（VT ） ,and minute ventilation volume（VE） were measured in the last 10 minutes of 30 minutes. In the mean time blood gas was measured too. Results △Peso, △Pdi, PTPeso, PTPdi, PEEPi and P0.1 were significantly higher during BIPAP than those during BiPAP （ P 〈0.05）. Compared with BiPAP,VE and VT decreased markedly during BIPAP （ P 〈0. 05） ,PaCO2 increased obviously （ P 〈0.05）. There was no difference in RR and PaO2. Conclusions BiPAP is superior for reducing their respiratory muscle effort and improving ventilation than BIPAP in spontaneously breathing COPD patients.