无创通气对清醒状态慢性阻塞性肺疾病患者呼吸动力的影响

Effect of noninvasive positive pressure ventilation on respiratory dynamics with chronic obstructive pulmonary disease in wake

目的 探讨无创正压通气（NIPPV）对清醒状态慢性阻塞性肺疾病（COPD）患者呼吸动力的影响.方法 选择19例COPD急性加重期住院患者,治疗后病情稳定,通过食道-胃囊管法,检测气道开口压、食道压和胃内压,层流速仪测呼吸流速和容量改变.监测患者在清醒状态下自主呼吸及NIPPV时呼吸动力的变化.结果 ①对呼吸流速和肺通气的影响：吸气峰流速（PIF）、平均吸气流速（VT/Ti）、潮气量（VT）、分钟通气量（VE）在自主呼吸及NIPPV时,两组间变化差异无统计学意义.②对上气道阻力（Rua）和动态肺顺应性（CLdyn）的影响：自主呼吸时Rua（15.07±3.62）cm H2O·L-1·s-1、CLdyn（0.052±0.012）L/cm H2O,与自主呼吸比较,NIPPV时Rua减少6.91%（P＞0.05）、CLdyn增加44.23%（P＞0.05）.③对呼吸肌肉活动和呼吸努力的影响：自主呼吸时跨膈压（Pdi）（19.85±4.00）cm H2O、食道负压（Pes）（-13.37±3.77）cm H2O,压力时间乘积（PTP）（287.79±95.14）cm H2O·s/min,与自主呼吸比较,NIPPV时Pdi下降61.96%（P＜0.001）,Pes负压减少67.83%（P＜0.001）,PTP下降58.80%（P＜0.01）.结论 NIPPV对清醒状态COPD患者吸气流速、肺通气量及上气道阻力无明显影响;NIPPV有效的降低了呼吸肌肉活动,减少呼吸努力,改善呼吸肌疲劳.

Objective To investigate the effection on respiratory dynamics in noninvasive positive pressure ventilation （NIPPV） of chronic obstructive pulmonary disease （COPD）in wake. Methods Nineteen hospitalized COPD patients in relatively stable condition were recruited. Esophageal and gastric balloon-catheters were used for the detection of esophageal pressure and gastric pressure and airway opening pressure. Airflow and ventilation were measured with pneumotachograph. Each patient underwent a nocturnal polysomnogram. Data was collected from patients in spontaneous breathing and NIPPV in wake. Results There were no significant differences between the spontaneous breathing and NIPPV of PIF、VT/Ti、VT、VE、Rua and CLdyn with COPD in wake（all P 〉0. 05）. The Pdi、Pes and PTP in NIPPV were significantly decresed compared with that of spontaneous breathing （ P 〈0. 05, or P 〈 0. 001,respectively）. Conclusions Studies shown NIPPV have no influence in airflow, ventilation and upper airway resistance with COPD in wake. NIPPV can reduce respiratory muscle activity and respiratory work, improve diaphragmatic fatigue.