Tei指数评价双水平正压通气治疗COPD并发呼吸衰竭患者的右心功能

Evaluation of bi-level positive airway pressure ventilation therapy on right ventricular function in COPD patients combined with respiratory failure by Tei index

目的利用超声心动图Tei指数观察双水平正压通气治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)并发呼吸衰竭患者右心功能的改善情况,探讨Tei指数对预测脱机是否有价值。方法选取COPD并发呼吸衰竭患者48例,入科后经口气管插管行机械通气,分别于入科第1天(上机前)、第2天和第5天行血气分析及床旁超声心动图检查,记录3个时点的心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、酸碱度(pH)、氧分压(arterial partial pressure of oxygen,PO_2)、二氧化碳分压(partial pressure of carbon dioxide,PCO_2)、氧饱和度(saturation oxygen,SO_2)、右心室前后径(right ventficular,RV)、右心室前壁厚度(right ventricular anterior wall thickness,RVAW)、肺动脉收缩压(pulmonary arterial systolic pressure,PASP)、右心室Tei指数,并行对比。根据入科第5天脱机是否成功,将患者分为脱机成功组(35例)和脱机失败组(13例),就2组患者3个时点的Tei指数进行比较。结果入科第2天和入科第5天所有患者的HR、RR、PCO_2明显低于入科第1天,pH、PO_2、SO_2明显高于入科第1天,PASP、Tei指数明显低于入科第1天(P<0.05)。3个时点所有患者RV、RVAW差异无统计学意义(P>0.05)。随时间延长,2组患者Tei指数总体均呈下降趋势,脱机成功组下降的幅度更大,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。结论对于COPD并发呼吸衰竭患者,采用双水平正压通气治疗可明显改善其症状及右心功能,提高治愈率;Tei指数是评价右心功能的较敏感指标,对预测脱机有一定价值。

Objective To examine the improvement of Bi-level positive airway pressure(BiPAP)ventilation therapy on right ventricular function in chronic obstructive pulmonary disease(COPD)patients combined with respiratory failure by Tei index.To discuss if Tei index is valuable to predict the time for taking off ventilatior.Methods Forty-eight cases of COPD patients combined with respiratory failure were selected in ICU of our hospital,all of whom were given invasive mechanical ventilation with oral trachea cannula.Then the blood gas analysis and bedside echocardiography were examined in the first day(before BiPAP therapy),the second day and the fifth day after entering ICU.The heart rate(HR),respiratory rate(RR),power of hydrogen(PH),partial pressure of oxygen(PO_2),partial pressure of carbon dioxide(PCO_2),saturation oxygen(SO_2),right ventricular diameter(RV),right ventricular anterior wall thickness(RVAW),pulmonary arterial systolic pressure(PASP)and right ventricular Tei index were recorded and compared among the three time spot.The patients were divided into two groups called successful taking-off group and failure taking-off group according to if they had been taken off ventilatiors or not in the fifth day.Tei index was compared between the two groups in the three different time spots.Results Compared with the indexes in the first day,the heart rate,respiratory rate and blood gas analysis of the patients were significantly improved and the PASP,right ventricular Tei index were significantly better in the second and fifth day(P<0.05),and the difference was statistically significant.While the difference of RV and RVAW had no statistical significance.The difference of all the index between the second day and the fifth day had no statistical significance.With the time lapsing,The Tei index of the two groups was in a downward trend and the dates of the successful taking-off group declined by a large margin.The difference between groups,among time spots and among crossover effect of time and grouping factor had statistical significance.Conclusion Invasive BiPAP ventilation can obviously improve the right ventricular function and cure rate in COPD patients combined with respiratory failure.Tei index is a sensitive index for evaluating right heart function and may be valuable to predict the time for taking off ventilatior.