紧急气管插管早期不同通气量对AECOPD患者预后的影响

Early effects of different ventilation volume after emergency endotracheal intubation on prognosis in acute exacerbation chronic obstructive pulmonary disease

目的探索慢性阻塞性肺疾病急性加重（AECOPD）患者紧急气管插管后不同通气量对患者预后的影响。方法选择AECOPD伴II型呼吸衰竭需要机械通气的患者40例,根据紧急气管插管后辅助通气量不同分为两组,I组（n=20）患者潮气量为10~15ml/kg,呼吸频率15~20次/min;II组（n=20）患者设置潮气量为6ml/kg,呼吸频率12次/min。监测气管插管前、辅助通气后5min、15min、30min的血气分析、血钾、血压、血氧饱和度,分析其变化规律。结果 I组机械通气30min后pH值大于7.45的患者12例,PaCO2下降超过40mmHg（1mmHg=0.133kPa）者10例;血钾下降（0.6±0.13）mmol/L,血压明显下降,应用血管活性药物8例,3例出现室性心律失常,2例心跳骤停死亡。II组机械通气30min后pH值大于7.45的患者6例,PaCO2下降大于40mmHg者4例;血钾下降（0.3±0.06）mmol/L,血压下降需要血管活性药物者2例,无死亡病例。结论 AECOPD伴呼吸衰竭患者,紧急气管插管后血压下降与机械通气后二氧化碳迅速排出、代谢性碱中毒、低钾血症、胸腔正压有关,AECOPD紧急气管插管早期低通气量辅助通气更安全。

Objective To observe the effects of different ventilation volume after emergency endotracheal intubation on prognosis in acute exacerbation chronic obstructive pulmonary disease（AECOPD）.Methods 40 patients with COPD accepted emergency endotracheal intubation and assisted ventilation in Intensive Care Unit（ICU） or general patients room or emergency were randomly divided into two subgroups（Vt10-15ml/kg and Vt 6ml/kg,RR15-20/min and 12/min）.The PH,PaCO2,PaO2,HCO3-,BP,HR,RR,SPO2,K＋ were monitored and recorded at the point before endotracheal intubation,5min,15mins,30mins after mechanical ventilation.Results Compare with patients of Vt 6ml/kg,patients of Vt 10-15ml/kg mechanical ventilation was significant difference（p0.05） at the depression of PaCO2,BP,K＋ and the increase of mortality.Conclusion Small Vt mechanical ventilation after emergency endotracheal intubation was safe for AECOPD.