摘要
目的比较持续气道正压(CPAP)通气与双水平气道正压(BiPAP)通气对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者血流动力学参数的影响。方法COPD合并呼吸衰竭患者31例,其中男性24例,女性7例,年龄(67±4)岁。给予常规内科治疗的同时,进行CPAP和BiPAP无创正压机械通气(NPPV)各60min,使用胸腔阻抗法监测患者在鼻导管吸氧自主呼吸以及接受不同通气模式支持时血流动力学参数、通气参数和动脉血气的变化。结果与自主呼吸相比,患者在CPAP通气后心率(HR)和平均动脉压(MAP)略有下降,而在BiPAP通气时呈明显下降(P<0.05)。BiPAP通气时患者的心输出量(CO)、心脏指数(CI)、搏出量(SV)和每搏指数(SI)与CPAP时相近,但低于未进行NPPV时。NPPV支持后射血前时间(PEP)明显缩短,对左室射血时间(LVET)则影响不大。CPAP时的浅快呼吸指数(RR/VT)为81.2±4.7,显著高于BiPAP时的53.6±2.9(P<0.05)。所有患者在NPPV支持时的PaO2/FiO2较鼻导管吸氧时显著增高,PaCO2则有所降低。结论COPD呼吸衰竭患者接受NPPV支持尤其是BiPAP通气后,患者的VT显著增加,相应PaO2/FiO2也明显增高,而PaCO2呈逐步下降,患者RR/VT的降低则反映其呼吸肌做功的减少,氧耗量降低。血流动力学参数中CO、CI、SV等均较鼻导管吸氧时明显下降,但不同NPPV模式对上述参数的影响却无差异。CPAP与BiPAP通气时患者的PEP明显下降,说明患者的心脏收缩能力得到增强。
Objective To compare the Hemodynamic effects of noninvasive continuous positive airway pressure（CPAP） and noninvasive bi-level positive airway pressure （BiPAP） on patients with chronic respiratory failure. Methods 31 chronic obstructive pulmonary disease （COPD） with chronic respiratory failure（age 67±4.00 years） underwent NPPV via full-face mask for 60 mins, the hemodynamic parameters were monitored by thoracic electrical bioimpedance technique, meanwhile ventilation parameters and arterial blood gas were measured. Results Compared with spontaneous breathing, patients＇ heart rate（HR） and mean arterial pressure（MAP） decreased on a small scale during CPAP, and significantly decreased during BiPAP （ P〈0.05）. Cardiac output（CO） ,stroke volume（SV） ,cardiac index（CI） ,stroke index（SI） and preejection period（PEP）were significantly lower during NPPV,but no difference was found between CPAP and BiPAP. Tidal volume （VT） and oxygenation （PaO2/FiO2） were obviously increased during NPPV, ;PaCO2 decreased but there was no significance （P〉0.05）. Rapid shallow breathing index （RR/VT） was significantly decreased during BiPAP [（ 53.6 ±2.9） versus （ 81.2 ±4.7 ）, P〈0.05]. Conclusions Supported by NPPV especially by BiPAP, work of breathing （WOB）, oxygenation, CO, SV and PEP in COPD were improved significantly. Left ventricular ejection time （LVET） was stable. There were no hemodynamic difference between patients underwent CPAP and BiPAP.
出处
《国外医学（呼吸系统分册）》
2005年第12期881-883,共3页
Section of Respiratory System Foreign Medical Sciences
关键词
血流动力学
无创正压通气
慢性阻塞性肺疾病
呼吸衰竭
Hemodynamics
Noninvasive positive pressure ventilations Chronic obstructive pulmonary disease
Respiratory failure
