无创机械通气不同吸气压力对慢性阻塞性肺疾病急性加重期患者腹内压的影响

Influence of inspiratory positive airway pressure on intra - abdominal pressure in acute exacerbation chronic obstructive pulmonary disease patients with noninvasive positive pressure ventilation

目的探讨不同吸气压力（IPAP）对慢性阻塞性肺疾病急性加重期（AECOPD）无创正压机械通气患者腹内压（IAP）的影响。方法选取60例AECOPD无创正压机械通气患者，行机械通气前测量患者IAP值，行无创正压机械通气后，按照正压机械通气不同吸气压力将患者随机分为三组：10-14cmH2O（A组），15～19cmH20（B组），20～25cmH2O（C组）；每组各20例患者，分别于调整吸气压力后2h、第1～7天每天同一时间点监测患者IAP。结果与A组、B组比较，C组患者IAP差异有统计学意义（P〈0．05）；A组与B组比较差异无统计学意义（P〉0．05）。同一组不同监测时间点比较，通气后2h及通气后第1天与其他时间点比较差异有统计学意义（P〈0．05）。结论对于AECOPD无创正压机械通气患者，随着吸气压力水平的升高，患者IAP有升高趋势，并且在早期较明显。因此，在无创正压机械通气早期，监测患者IAP可能有益于为患者选择适合的吸气压力支持水平。

Objective To study the noninvasive positive pressure ventilation patients different inspiratory positive airway pressure of intra - abdominal pressure for acute exacerbation chronic obstructive pulmonary disease. Methods select 60 cases of patients with AECOPD, measuring intra - abdominal pressure before mechanical ventilation, then adjust the pressure support to the best level. According to the different inspiratory positive airway pressure level divided the patients into three groups randomly ： 10 - 14 cm H20 （ group A）, 15 - 19 cm H20 （ group B）, 20 - 25 cm H20 （ group C ）, every group have 20 patients. Then measure intra - abdominal pressure after mechanical ventilation on 2 h, from the first day to the seventh day. Results Compared with group A and B, the intra - abdominal pressure in group C were statistically significant （ P 〈 0. 05 ）. The group A and group B have no statistical difference （P 〉 0. 05）. In the same group of different monitoring point time, comparison with others time, the intra - abdominal pressure in 2 h and the first day were statistically significant （ P 〈 0. 05）. Conclusion For AECOPD noninvasive positive pressure ventilation patients, with inspiratory positive airway pressure level increased, the intra - abdominal pressure increased, especially in the early. Therefore, for the noninvasive positive pressure mechanical ventilation patients, early detection of intra- abdominal pressure may be beneficial for patients to choose suitable inspiratory positive airway vressure level.