最大跨膈压、最大吸鼻跨膈压和颤搐性跨膈压在评价COPD患者膈肌功能中的价值

The value of maximal transdiaphragmatic pressure,sniff transdiaphragmatic pressure and twitch transdiaphragmatic pressure on evaluation of the diaphragmatic function of patients with COPD

目的探讨最大跨膈压、最大吸鼻跨膈压和颤搐性跨膈压在评价COPD患者膈肌功能中的价值，寻找更加可靠的评价膈肌功能指标，以便指导临床呼吸机撤机时机选择。方法选取2013年2月～2013年11月来我院就诊的慢性阻塞性肺疾病急性加重（AECOPD）需行机械通气患者76例，依据患者检测指标最大跨膈压、最大吸鼻跨膈压和颤搐性跨膈压水平的不同将患者分为实验组及常规组，常规组最大跨膈压〈7．00kPa，最大吸鼻跨膈压〈6．00kPa，颤搐性跨膈压〈1．00kPa；实验组最大跨膈压≥7．00kPa，最大吸鼻跨膈压≥6．00kPa，颤搐性跨膈压≥1．00kPa；依据临床常规撤机指标对患者进行尝试性撤机，观察两组患者进行自主呼吸试验（SBT）前、20分钟后及40分钟后患者的动脉血氧饱和度（PaO2）、动脉血二氧化碳饱和度（PaCO2）、氧合指数（OI）、出现紫绀例数及撤机成功率。结果两组患者SBT前的PaO2、PaCO2、OI均无明显差异（P〉0．05），SBT20分钟及40分钟后实验组患者的PaO2及OI明显高于常规组（P〈0.05），实验组的PaCO2及紫绀例数明显少于常规组（P〈0.05）；实验组的撤机成功率明显高于常规组（P〈0，05）。结论最大跨膈压、最大吸鼻跨膈压和颤搐性跨膈压可有效反映患者的膈肌功能状态，从而为临床AECOPD患者的撤机进行更为准确的指导。

Objective To explore the value of maximal transdiaphragmatic pressure, sniff transdiaphragmatic pres- sure and twitch transdiaphragmatic pressure on evaluating the diaphragmatic function of patients with COPD. Methods 76 cases of acute exacerbation of chronic obstructive pulmonary disease（AECOPD） patients were were divided into exper- imental group and control group according to the degree of the maximal transdiaphragmatic pressure, sniff transdiaphrag- matic pressure and twitch transdiaphragmatic pressure. There were 38 cases of patients in each group. The index of the control group were Maximal transdiaphragmatic pressure〈7.00 kPa, Sniff transdiaphragmatic pressure〈6.00 kPa, and Twitch transdiaphragmatic pressure〈1. 00 kPa, The index of the experimental group were Maximal transdiaphragmatic pressure≥7.00 kPa, Sniff transdiaphragmatic pressure≥6.00 kPa, and Twitch transdiaphragmatic pressure≥l. 00 kPa. Based on clinical indicators of conventional to attempt to weaning and the arterial oxygen saturation （PaO2）, arterial satu- ration of carbon dioxide （PaCO2）, oxygenation index （OI） ,cyanosis number of cases and the success rate of weaning were observed in patients before autonomic breathing trial （SBT）, after 20 minutes and after 40 minutes. Results There was no statistically significant difference on detect targets between the two groups of patients before treatment （P〉0.05）. The PaO2 and OI of experimental group were significantly higher than that of control group 20 minutes and 40 minutes of SBT （P〈0.05）. The cyanosis number of cases of experimental group was significantly lower than that of control group（P〈0. 05）. The success rate of weaning of experimental group was significantly higher than that of control group（P〈0. 05）. Conclusion The Maximal transdiaphragmatie pressure, Sniff transdiaphragmatic pressure and Twitch transdiaphragmatic pressure can maximum pressure across the diaphragm, the maximum absorption across the nasal septum pressure and twitch transdiaphragmatic pressure can evaluate the diaphragmatic function effectively, which can give the AECOPD pa- tients a more accurate guide for weaning.