俯卧位呼吸时悬空腹部对呼吸动力学的影响

Effects of hanging free the abdomen in prone position on mechanics of respiratory and cardiovascular system

目的 :探讨稳定期慢性阻塞性肺疾病(COPD)患者和健康志愿者在俯卧位状态下是否悬空腹部对呼吸和循环动力学的影响。方法:12例稳定期COPD患者和9名健康志愿者采取仰卧位、俯卧位悬空腹部、俯卧位3种不同体位,通过NICO和BioZ无创心肺功能监测仪连续测定患者的呼吸和循环动力学指标,通过呼吸功能检测电极测定膈肌肌电、跨膈压(Pdi)等指标,每个体位均观察10 min。结果:1呼吸动力学:健康志愿者俯卧位的Pdi与俯卧位悬空腹部和仰卧位比较显著升高[(13.5±1.6)比(11.5±2.2)、(10.1±1.7)cmH_2O(1 cmH_2O=0.098 kPa),P<0.05],稳定期COPD患者俯卧位的Pdi与俯卧位悬空腹部和仰卧位比较明显升高[(22.6±2.5)比(15.6±2.6)、(18.2±3.2)cmH_2O,均P<0.05];2循环动力学:健康志愿者俯卧位的心指数(CI)显著高于俯卧位悬空腹部和仰卧位[(5.01±0.73)比(4.26±0.47)、(4.39±0.39)L/(min·m^2),均P<0.01],稳定期COPD患者仰卧位的CI显著高于俯卧位悬空腹部和俯卧位[(4.31±0.45)比(3.85±0.61)、(3.42±0.59)L/(min·m^2),均P<0.01],外周血管阻力指数(SVRI)在俯卧位时显著高于俯卧位悬空腹部[(1 960.9±307.9)比(1 701.9±422.5)dyn·s·cm^(-5)·m^2,P<0.05)]。结论:健康志愿者或稳定期COPD患者在俯卧位悬空腹部,均能降低Pdi改善膈肌的运动能力,对稳定期COPD俯卧位时悬空腹部能减轻心脏的负荷。

Objective To study the effects of hanging free the abdomen in prone position（PP） on the mechanics of respiratory and cardiovascular system in patients with chronic obstructive pulmonary disease（COPD） and healthy controls.Methods Twelve stable COPD patients and 9 healthy controls were enrolled and were studied in supine position（SP）, PP with the abdomen hanging free（PAF） and PP with the abdomen right on the table, with each position studied for 10 min.NICO, BioZ and respiratory function test electrode were used to monitor respiratory and hemodynamic parameters. Results 1 Mechanics of respiratory system： in healthy controls, trans-diaphragmatic pressure（Pdi） in PP was significantly higher than that in PAF and SP[（13.5±1.6） vs（11.5±2.2）,（10.1±1.7） cmH^2O, 1 cm H2O=0.098 kPa, P0.05]; in stable COPD patients, Pdi in PP was significantly higher than that in PAF and SP[（22.6±2.5） vs（15.6±2.6）,（18.2±3.2） cmH^2O, P0.05]. 2Mechanics of cardiovascular system： in healthy controls, cardiac index（CI） in SP was significantly higher than that in PAF and PP[（5.01±0.73） vs（4.26±0.47）,（4.39±0.39） L/（min·m^2）, P0.01]; in stable COPD patients, CI in SP was significantly higher than that in PAF and PP [（4.31±0.45） vs（3.85±0.61）,（3.42±0.59） L/（min·m^2）, P0.01], SVRI in PP was significantly higher than that in PAF[（1 960.9±307.9） vs（1 701.9±422.5） dyn·s·cm^（-5）·m^2, P0.05]. Conclusions Hanging free the abdomen in PP would decrease the Pdi and improve diaphragmatic motion no matter for stable COPD patients or healthy controls.For COPD patients, hanging free the abdomen would diminish the increase of cardiac load in PP.