氦-氧混合气体治疗重症慢性阻塞性肺病

目的：探讨吸入氦－氧混合气对重症慢性阻塞性肺病（COPD）机械通气患者的治疗作用以及对机械通气患者脱机的作用。方法：选择12例重症COPD机械通气患者随机分为氦－氧混合气组（70％氦；30％氧）和对照组（FiO2:30%),观察治疗前、治疗后30、90min、6h的呼吸力学指标（气道峰压、平台压、吸气阻力、呼气阻力）以及内源性呼气末正压的变化；选择准备脱机的机械通气患者6例，按自身对照方式脱机后随机先后吸入氦－氧混合气，（70％氦－30％氧）和低浓度氧（FiO2:30%)观察治疗前、治疗后30、90min、6h和停止治疗后30min(重新上机进行压力支持通气）的动脉血气指标。结果：机械通气患者应用氦氧混合气治疗后气道压力、气道阻力和内源性呼气末正压均有明显下降，与对照组比较差异有显著性意义；脱机患者吸入氦－氧混合气后与对照组比较pH、PaO2、PaCO2差异均具有显著性意义。结论：吸入氦－氧混合气在治疗重症COPD机械通气患者方面能够明显降低气道压力和气道阻力，避免气压伤的发生；应用氦氧混合气可以有效避免脱机患者血气指标的恶化，可以有助于患者的顺利脱机。

Effects of helium-oxygen mixture in mechanically ventilated patients with severe chronic obstructive pulmonary disease

Objective To test the effects of helium oxygen mixture(heliox,70%helium/30%oxygen)in decreasing airway pressure and airway resistance,as well as improving weaning from ventilators in mechanically ventilated patients with chronic obstructive pulmonary disease(COPD).Methods 12 ventilated patients with severe COPD in the department of respiratory medicine were enrolled.The patients were randomly divided into heliox group(6 cases)and control group (6 cases).The heliox group inhaled heliox and the controll group inhaled nitrogen oxygen(FiO 2:30%).The results of peak pressure(Ppeak),pause pressure(Ppause),inspiratory resistance(Ri),expiratory resistance(Re),and intrinsic positive end expiratory pressure(PEEPi)at before treatment,30,90 min,and 6 hours after treatment were recorded.6 patients of preparing for weaning ventilators were randomly breathing heliox(heliox,70%helium/30%oxygen)or nitrogen oxygen(FiO 2:30%)according to self control style.The results of arterial blood gas at before treatment,30,90,180 min after treatment,and 30 min after stopping breathing heliox were measured.Results In the ventilated patients,there existed statistical differences in Ppeak,Ppause,Ri,Re,and PEEPi between heliox group and controlled group.Airway pressure and airway resistance obviously decreased after inhaling heliox.The results of arterial blood gas also ameliorated after breathing heliox contrast with breathing low concentration oxygen in the patients preparing for weaning from ventilators.Conclusion In mechanically ventilated COPD patients,the use of heliox can markedly decrease airway pressure,airway resistance,and PEEPi.Breathing heliox might be beneficial in reducing the risk of barotraumas,and weaning from ventilators in these patients[