Impact of different inspiratory flow patterns on arterial C02-tension

Ventilation with decelerating inspiratory flow is known to reduce the dead space fraction and to decrease PaCO2. Constant inspiratory flow with an end-inspiratory pause (EIP) is also known to increase the removal of CO2. The aim of the study was to elucidate the effect of the pause/no-flow period while both the pattern and rate of inspiratory flow was unchanged, and when the lung was ventilated with sufficient PEEP to prevent end-expiratory collapse. Surfactant depleted piglets were assigned to decelerating or constant inspiratory flow with 24 breaths per minute (bpm) or 12 bpm, or to constant flow, without and with an end-inspiratory pause of 25%. By adding an EIP the total time without active inspiratory flow of the respiratory cycle was kept unchanged. Gas exchange, airway pressures, functional residual capacity (using sulfurhexafluoride) and haemodynamics (thermo-dye indicator dilution technique) were measured. Irrespective of ventilatory frequency, PaCO2 was lower and serial dead space reduced with decelerating flow, compared with constant inspiratory flow. With an end-inspiratory pause added to constant inspiratory flow, serial dead space was reduced but did not decrease PaCO2. The results of this study corroborate the assumption that total time without active inspiratory flow is important for arterial CO2-tension.     

不同吸气末停顿及吸呼比对胸科手术 单肺通气患者呼吸功能的影响

目的 探讨需单肺通气（OLV）的胸科手术中不同吸气末停顿（EIP）及吸呼比对患者呼吸功能的 影响。方法 选择该院择期行胸科手术OLV 患者60 例，根据随机数字表法将其分为OLV 吸呼比1 ∶ 2 组（A 组） 和OLV 吸呼比1 ∶ 1 组（B 组），每组30 例。将两组根据吸气末停顿设置的不同分别随机分为2 个亚组，即 OLV 后吸呼比1 ∶ 2，吸气末停顿0%、10%、20% 先后通气30 min 组（A1 组）；吸气末停顿0%、20%、10% 先后通气30 min 组（A2 组）；OLV 后吸呼比1 ∶ 1，吸气末停顿0%、10%、20% 先后通气30 min 组（B1 组）； 吸气末停顿0%、20%、10% 先后通气30 min 组（B2 组）。每组15 例。分别于OLV 前（T1）、OLV 后30 min（T2）、 60 min（T3）、90 min（T4）记录患者血流动力学指标、呼吸力学指标并采集动脉及中心静脉血进行血气分析。 结果 在A 组与B 组中，吸气末停顿20% 与吸气末停顿0%、10% 比较，患者动脉血二氧化碳分压（PaCO2）、死 腔率降低（P <0.05）。B 组在联合吸气末停顿0%、10%、20% 时与A 组比较，患者气道压峰值、平台压降低，肺顺 应性提高（P <0.05）。结论 对胸科手术OLV 患者，吸气末停顿20% 有利于二氧化碳交换，减少死腔率；吸 呼比1 ∶ 1 可降低气道压，提高肺动态顺应性。两者对患者血流动力学指标无影响。     

容量控制通气流速波型对慢性阻塞性肺疾病肺生理效应的研究

目的: 比较分析容量控制通气中减速波、恒速波(方形波)及正弦波3种吸气流速波型对慢性阻塞性肺疾病(COPD)患者肺生理如呼吸力学及气体交换的影响.方法:18名经鼻或经口气管插管连接呼吸机进行容量控制通气的COPD患者,设定潮气量、呼吸频率、吸入氧浓度恒定不变,分别于固定吸呼比和固定峰流速两种情况下,随机选择减速波、恒速波及正弦波,同时进行床头肺功监测.同时测定动脉血气并记录心率、血压、Pa-etCO2等指标.结果:(1)血气:在峰流速一定时,恒速波时PaCO2与减速波相比显著降低(P＜0.05),而在吸呼比一定时PaCO2无差异.两种情况下PaO2、心率、平均动脉压、Pa-etCO2均无差异(P＞0.05).(2)呼吸力学:在两种情况下,呼吸系统动态顺应性、平均气道压减速波时最大,恒速波最低;气道峰压减速波最低,恒速波最高,以上均无统计学意义(P＞0.05);食道压波动、气道平均阻力减速波最小,恒速波最大(P＜0.05);呼吸机做功三者之间无显著差别.结论:3种不同的吸气流速波型(减速波、恒速波、正弦波)对COPD患者动脉血气分析及呼吸力学均存在不同效应.减速吸气流速波型可以降低气道阻力,减速波时气道峰压较低,可以减少气压伤的发生,但减速波时平均气道压较高,而恒速波的优势就在于平均气道压较低,并且在峰流速相同的情况下,恒速波可以降低PaCO2,正弦波介于二者之间.     

A recruitment breath manoeuvre directly after endotracheal suction improves lung function: An experimental study in pigs

Background. Atelectasis occurs after a well performed endotracheal suction. Clinical studies have shown that recruitment manoeuvres added after endotracheal suction during mechanical ventilation restore lung function. Repetitive lung over-distension is, however, harmful for the lung, and the effects of adding a larger breath, recruitment breath, directly after repeated endotracheal suction were therefore investigated.

Methods. Twelve healthy anaesthetized pigs were randomized into two groups: one without and one with a recruitment breath manoeuvre (RBM), i.e. a breath 15 cmH₂O above inspiratory pressure for 10 s during pressure-controlled ventilation. The pigs were suctioned every hour for 4 hours with an open suction system.

Results. At the end of the study there was a statistically significant difference between the group given RBM and that without with respect to PaCO₂, tidal volume (V_T), and compliance (Crs). Without RBM, the PaCO₂ increased from 4.6±0.4 to 6.1±1.5 kPa, V_T decreased from 345±39 to 247±71 mL, and Crs decreased from 28±6 to 18±5 mL/cmH₂O. There was no change in PaCO₂ or Crs when a RBM was given. Morphological analysis revealed no differences in aeration of apical and central lung parenchyma. In the basal lung parenchyma there were, however, greater areas with normal lung parenchyma and less atelectasis after RBM.

Conclusions. Atelectasis created by endotracheal suction can be opened by inflating the lung for a short duration with low pressure, without over-distension, immediately after suction.     

不同流速模式同步间歇指令通气和压力调节容量控制通气的呼吸力学与能量代谢

目的 比较恒速与减速同步间歇指令通气(SIMV)和压力调节容量控制(PRVC)3种呼吸模式在呼吸力学和能量代谢方面的异同。方法选取28例房、室间隔缺损修补术后患者,分别采用2种不同流速模式的SIMV(恒速和减速)和PRVC模式进行机械通气,观察气道峰压、气道阻力、心率、血压、中心静脉压、氧耗、能量代谢以及血气分析等指标的变化。结果 恒速SIMV模式的气道峰压、气道阻力、氧耗与能量代谢均明显高于减速SIMV与PRVC模式(P<0.01);而减速SIMV与PRVC模式间的上述指标无显著差异(P>0.05);3种模式间其他指标无显著性差异(P>0.05)。结论减速SIMV与PRVC模式可以有效地降低气道压力、气道阻力,还可以明显降低机械通气期间的氧耗与能量消耗,有利于疾病的康复。     

Effects of Breath Training Pattern “End-Inspir atory Pause” on Respiratory Mechanics and Arterial Blood Gas of Pa tients with COPD

Bｒｅａｔｈｉｎｇｔｒａｉｎｉｎｇｉｓａｎｉｍｐｏｒｔａｎｔａｐ ｐｒｏａｃｈｉｎｒｅｈａｂｉｌｉｔａｔｉｏｎｏｆ ｐａｔｉｅｎｔｓｗｉｔｈｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅ ｐｕｌｍｏｎａｒｙｄｉｓｅａｓｅ（ＣＯＰＤ）．Ｌｏｔｓｏｆｒｅｐｏｒｔｓ（1，2 ）     

肺结核患者单肺通气时PetCO2和PaCO2的相关性研究

肺结核患者肺组织常有渗出浸润、增殖纤维化或钙化、干酪样坏死等病变,导致通气血流比值失调、CO2弥散障碍,因而这类患者在单肺通气下行肺部手术时需密切监测二氧化碳分压（PaCO2）。临床上常采用无创的呼气末二氧化碳分压（PetCO2）进行监测。既往文献报道PaCO2与PetCO2之间具有良好的相关性,但近年研究表明,PetCO2与PaCO2的相关性受诸多因素影响,如体位、二氧化碳气腹、单肺通气、创伤及肺组织病变等。本文通过观察PetCO2和PaCO2的变化,以期了解肺结核患者手术行单肺通气时PetCO2和PaCO2的变化及相关性,为临床提供通气维持依据。     

Clinical studies on high frequency two-way jet ventilation

Summary A new mode of jet ventilation, high frequency two-way jet ventilation (HFTJV) was devised and introduced to increase carbon dioxide elimination during jet ventilation. Its ventilatory efficiency and features were investigated and compared with those of high frequency jet ventilation (HFJV) in 10 patients with normal cardiopulmonary function. Random sample selection and randomized cross-over trial were used for comparison between HFTJV and HFJV at the same ventilatory settings of driving pressure 1 kg/cm² (14.22 Psi), respiratory rate 100/min and I/E ratio 1:2. Peak inspiratory pressure (PIP), end-expiratory pressure (EEP) and main variables of air blood gas analysis (PaO₂, PaCO₂, pH) were measured and recorded during the use of HFJV and HFTJV. PIP and EEP were significantly lower than with HFTJV than with HFJV. EEP of HFTJV showed a slightly negative pressure (−0.17±0.03 kPa). PaCO₂ with HFTJV was significantly lower than that with HFJV, but Pa₂ and pH with HFTJV were significantly higher than those with HFJV. HFTJV was shown to have a ventilatory feature of decreasing airway pressure and simultaneously increasing carbon dioxide elimination, as compared with HFJV. Whether this ventilatory feature of HFTJV can be utilized for various respiratory support in patients with abnormal cardiopulmonary function needs to be further studied.     

Effects of breath training pattern “end-lnspiratory pause” on respiratory mechanics and arterial blood gas of patients with COPD

Objective  

In order to explore the mechanism of Chinese traditional breath training, the effects of end-inspiratory pause breathing (EIPB) on the respiratory mechanics and arterial blood gas were studied in patients with chronic obstructive pulmonary disease (COPD).     

持续呼吸末正压给氧在婴幼儿毛细支气管炎中的临床应用

目的 探讨持续呼吸末正压给氧治疗婴幼儿毛细支气管炎的有效性、安全性。方法将2015年1~12月在本院儿科重症监护室确诊为毛细支气管炎的病人160例回顾性分为对照组与治疗组,每组80例,对照组予持续低流量吸氧,治疗组予持续呼吸末正压给氧辅助通气。分析两组治疗后6、24 h呼吸(R)、心率(HR)及血氧饱和度(SO₂)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、血清乳酸浓度(Lac)等血气值。治疗4天后,比较两组疗效,观察并记录两组喘憋、咳嗽以及肺部湿啰音等主要临床症状消失时间。结果在治疗后6、24 h,治疗组R、HR、PaCO₂、Lac较对照组降低(P<0.05或0.01),SO₂、PaO₂较对照组升高(P<0.05或0.01)。治疗4天后,治疗组总有效率明显高于对照组(P<0.05)。与对照组比较,治疗组喘憋、咳嗽与肺部湿啰音消失时间缩短(P<0.05)。结论采用持续呼吸末正压辅助通气治疗婴幼儿毛细支气管炎可以提高疗效,缩短疗程,改善愈后。     

参脉注射液联合酚妥拉明治疗COPD合并肺动脉高压的临床疗效

探讨参脉注射液联合酚妥拉明治疗慢性阻塞性肺疾病(COPD)合并肺动脉高压的临床疗效。选取COPD合并肺动脉高压患者50例,常规治疗组给予酚妥拉明,联合治疗组在常规治疗组基础上加用参脉注射液,比较两组患者的动脉血气状况(PaO₂、PaCO₂)、肺动脉平均压、不良反应发生率和治疗后总有效率。结果显示,治疗后联合治疗组PaO₂、PaCO₂、肺动脉平均压和治疗后总有效率均显著优于常规治疗组。上述结果提示,参脉注射液联合酚妥拉明治疗COPD合并肺动脉高压可有效改善患者血氧状况,降低肺动脉压,且安全可靠。     

压力控制容量保证通气中不同吸气流速对单肺通气患者呼吸功能的影响*

目的 探讨在压力控制容量保证通气下不同吸气流速对胸科单肺通气患者呼吸功能的影响。方法 择期行单侧肺病损切除术的单肺通气全身麻醉患者75例。随机分为3组,吸气流速30?L/min组（A组）,吸气流速50?L/min组（B组）,吸气流速70?L/min组（C组）,每组25例。分别于单肺通气前5?min（T0）、单肺通气后30?min（T1）、60?min（T2）、120?min（T3）记录气道峰压（Ppeak）、气道平台压（Pplat）并行血气分析,计算动态肺顺应性（Cdyn）、死腔率（VD/VT）、氧合指数（PaO2/FiO2）和分流率（Qs/Qt）。结果 不同时间点的动脉血 二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、中心静脉血氧饱和度（ScvO2）、Ppeak、Pplat、呼气末正压（PEEP）、VD/VT、Cdyn、PaO2/FiO2、Qs/Qt有差异（P?<0.05）;3组间PaCO2、Ppeak、Pplat、PEEP、VD/VT、Cdyn有差异（P?<0.05）;3组间PaCO2、Ppeak、Pplat、PEEP、VD/VT变化趋势有差异（P?<0.05）。结论 在压力控制容量保证的单肺通气中,适当增加吸气流速可以在降低气道压的同时促使更有效的气体弥散,减少死腔率并改善肺动态顺应性。     

Neural control of pressure support ventilation improved patient-ventilator synchrony in patients with different respiratory system mechanical properties: a prospective,crossover trial

BackgroundConventional pressure support ventilation (PS_P) is triggered and cycled off by pneumatic signals such as flow. Patient-ventilator asynchrony is common during pressure support ventilation, thereby contributing to an increased inspiratory effort. Using diaphragm electrical activity, neurally controlled pressure support (PS_N) could hypothetically eliminate the asynchrony and reduce inspiratory effort. The purpose of this study was to compare the differences between PS_N and PS_P in terms of patient-ventilator synchrony, inspiratory effort, and breathing pattern.MethodsEight post-operative patients without respiratory system comorbidity, eight patients with acute respiratory distress syndrome (ARDS) and obvious restrictive acute respiratory failure (ARF), and eight patients with chronic obstructive pulmonary disease (COPD) and mixed restrictive and obstructive ARF were enrolled. Patient-ventilator interactions were analyzed with macro asynchronies (ineffective, double, and auto triggering), micro asynchronies (inspiratory trigger delay, premature, and late cycling), and the total asynchrony index (AI). Inspiratory efforts for triggering and total inspiration were analyzed.ResultsTotal AI of PS_N was consistently lower than that of PS_P in COPD (3% vs. 93%, P = 0.012 for 100% support level; 8% vs. 104%, P = 0.012 for 150% support level), ARDS (8% vs. 29%, P = 0.012 for 100% support level; 16% vs. 41%, P = 0.017 for 150% support level), and post-operative patients (21% vs. 35%, P = 0.012 for 100% support level; 15% vs. 50%, P = 0.017 for 150% support level). Improved support levels from 100% to 150% statistically increased total AI during PS_P but not during PS_N in patients with COPD or ARDS. Patients’ inspiratory efforts for triggering and total inspiration were significantly lower during PS_N than during PS_P in patients with COPD or ARDS under both support levels (P < 0.05). There was no difference in breathing patterns between PS_N and PS_P.ConclusionsPS_N improves patient-ventilator synchrony and generates a respiratory pattern similar to PS_P independently of any level of support in patients with different respiratory system mechanical properties. PS_N, which reduces the trigger and total patient''s inspiratory effort in patients with COPD or ARDS, might be an alternative mode for PS_P.Trial RegistrationClinicalTrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT01979627","term_id":"NCT01979627"}}NCT01979627; https://clinicaltrials.gov/ct2/show/record/{"type":"clinical-trial","attrs":{"text":"NCT01979627","term_id":"NCT01979627"}}NCT01979627.     

枸橼酸咖啡因维持治疗对呼吸窘迫综合征早产儿机械通气后过渡性撤机的影响

目的 探讨枸橼酸咖啡因维持治疗对呼吸窘迫综合征（NRDS）早产儿机械通气后过渡性撤机的影响。方法 选取2019年5月—2021年10月三二〇一医院收治的82例NRDS早产儿作为研究对象,有创机械通气撤机后将早产儿分为对照组（经鼻间隙正压通气+氨茶碱治疗）和观察组（经鼻间隙正压通气+枸橼酸咖啡因维持治疗）,每组41例。对比两组早产儿撤机成功率和救治成功率。对比两组早产儿撤机后不同时刻（首次撤机即刻、撤机后48 h和撤机后72 h）血气指标[血氧分压（PaO2）、二氧化碳分压（PaCO2）]、呼吸力学指标[气道阻力和内源性呼气末正压（PEEPi）]及血清学指标[铁蛋白（SF）、促肾上腺皮质激素（ACTH）]。对比两组早产儿住院期间并发症发生情况。结果 观察组撤机成功率和救治成功率高于对照组（P <0.05）。两组早产儿首次撤机即刻、撤机后48 h、72 h的PaO2、PaCO2、气道阻力、PEEPi、SF、ACTH比较,经重复测量设计的方差分析,结果：(1)不同时间点PaO2、PaCO2、气道阻力、PEEPi、SF、ACTH有差异（P <0.05）;(2)两组早产儿PaO2、P...     

中老年人动脉血二氧化碳分压参考值的地理分布规律

目的 研究我国健康中老年人动脉血二氧化碳分压参考值与地理因子之间的关系,为制定不同地域的标准提供科学依据。方法 收集66个市县5038例健康中老年人的动脉血二氧化碳分压参考值,运用相关分析的方法研究其与地势、气候、土壤有关的25项地理指标之间的关系,并且推导出参考值与地理指标之间的回归方程：Ŷ=4.029+0.7140X₃-0.002000X₄+0.9240X₅+0.8760X₉-0.9130X₁₃+4.599X₁₄±3.29。运用克里金插值法拟合出参考值的空间分布趋势图。结果 动脉血二氧化碳分压参考值与地理指标间存在显著的相关关系。从大体上看,参考值的分布图呈现出东部高西南低的分布特征。结论 若已知中国某地的纬度（X₃）、年日照时数（X₄）、年平均气温（X₅）、年平均风速（X₉）、表土碱度（X₁₃）、表土盐分（X₁₄）,可用此方程计算出该地区健康中老年人动脉血二氧化碳分压参考值,也可以通过查询参考值地理分布图得出某地区该参考值的范围。     

Noninvasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure

Noninvasive positive pressure ventilation (NIPPV) delivered by nasal route or facemask is increasingly being used in the management of patients with acute respiratory failure. 45 patients (29 males,16 females) with a mean age of 68.32 years (range 29 to 82 years) having acute onset hypoxemic and/or hypercapnic respiratory failure who were managed with NIPPV in a tertiary care centre of Armed Forces were analyzed retrospectively. Patients with hemodynamic instability, coma and uncooperative patients were excluded from study. Etiology of acute respiratory failure was acute exacerbation of chronic obstructive pulmonary disease (COPD) in 29 patients, adult respiratory distress syndrome (ARDS) in 4 patients, severe kyphoscoliosis in 2 patients, interstitial lung disease (ILD) in 4 patients, lung contusion with pneumonia in 1 patient, thoracoplasty in 1 patient and difficult weaning in 4 patients. Initial resting arterial blood gases showed mean arterial oxygen tension (PaO₂) 61 mmHg (range 45 to 78 mmHg), mean arterial carbon dioxide tension (PaCO₂) 75.2 mmHg (range 32 to 127 mmHg) and mean arterial pH-7.26 (range 7.03 to 7.45). Mean inspiratory positive airway pressure (IPAP) was 14 cm H₂O (range 10 to 20 cm H₂O). Mean expiratory positive airway pressure (EPAP) was 5.8 cm H₂O (range 4 to 8 cm H₂O). On an average, NIPPV was required for 5.4 days (range 2 to 15 days) prior to discharge. 11 patients required long term intermittent NIPPV along with domiciliary oxygen therapy. 9 patients died out of which 4 patients had advanced interstitial lung disease. NIPPV has been found useful in acute respiratory failure due to acute exacerbations of COPD, thoracic wall abnormalities and ARDS. It has not been found useful in hypoxemic respiratory failure due to interstitial lung disease and diffuse interstitial pneumonia.Key Words: Acute respiratory failure, Arterial blood gases, Chronic obstructive pulmonary disease, Noninvasive positive pressure ventilation     

丹红注射液对老年慢性阻塞性肺疾病急性加重期患者内皮功能和血凝功能的影响

[目的]观察早期应用丹红注射液对老年慢性阻塞性肺疾病(COPD)急性加重期患者内皮功能和血凝功能的影响。[方法]236例老年COPD急性加重期患者随机分为对照组(118例)、观察组(118例)。对照组给予西医综合治疗,观察组给予常规西医综合治疗+参附注射液。动态监测内皮细胞功能包括E选择素(s E-selectin)和管性血友病因子(v WF);血凝学指标包括活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、血小板计数(PLT)和血栓弹力图检测(TEG);血气分析包括血氧分压(PaO_2)、血氧饱和度(SaO_2)和血二氧化碳分压(PaCO_2);应用中医证候评分评价病情好转情况。[结果]治疗前,两组s E-selectin、v WF、血凝学指标、血气指标以及证候评分,差异无统计学差异(P0.05)。治疗后,观察组PaO_2、SaO_2、PaCO_2以及中医证候评分改善情况优于对照组(P0.05);观察组s E-selectin、v WF、APTT、D-D、TEG的R值和K值低于对照组,PLT、a角和MA值高于对照组(P0.05)。[结论]丹红注射液可减轻老年COPD急性加重期患者内皮功能损伤、改善血凝状态,有利于患者的转归。     

体外循环期间不同通气模式对心脏手术患者肺功能的影响

目的 探讨体外循环期间实施不同的通气模式对心脏手术患者肺功能的影响.方法 以40例心脏瓣膜置换择期手术患者作为研究对象.根据患者体外循环期间接受的不同通气模式分为组Ⅰ（潮气量和呼气末气道正压均为0）、组Ⅱ（潮气量为5 mL/kg,呼气末气道正压为0）、组Ⅲ（潮气量为0,呼气末气道正压为10 cmH20）和组Ⅳ（潮气量为5 mL/kg,呼气末气道正压为10 cmH20）,每组10例.记录胸骨锯开前、体外循环结束即刻、关胸后及体外循环后4 h的肺功能和血流动力学相关参数,包括动脉氧分压（PaO2）、肺泡-动脉氧分压差（AaD02）、肺内分流率（Qs/Qt）、吸气峰压（PIP）、死腔容积与潮气量比（Vd/Vt）、肺动态顺应性（Cdyn）和心脏指数（CI）等,并进行统计学分析和比较.结果 与胸骨锯开前比较,体外循环后4 h时间点各组PaO2显著降低,CI显著升高（P＜0.05）;组Ⅰ和组Ⅱ的Qs/Qt、PIP、Vd/Vt显著升高,而Cdyn明显降低（P＜0.05）;组Ⅲ和组Ⅳ的AaDO2显著降低（P＜0.05）.在体外循环后4 h时间点,与组Ⅰ和组Ⅱ比较,组Ⅲ、组Ⅳ的PaO2和Cdyn明显增高（P＜0.05）,而AaDO2、Qs/Qt、Vd/Vt显著降低（P＜0.05）.结论 与单纯机械通气相比,心脏手术患者体外循环期间予以持续气道正压可明显减轻患者的肺功能损伤程度.     

Positive End-expiratory Pressure Titration after Alveolar Recruitment Directed by Electrical Impedance Tomography

Background:

Electrical impedance tomography (EIT) is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome (ARDS) during positive-end-expiratory pressure (PEEP) titration using EIT.

Methods:

Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study. After recruitment maneuvers (RMs), decremental PEEP titration was performed from 20 cmH₂O to 5 cmH₂O in steps of 3 cmH₂O every 5–10 min. Regional over-distension and recruitment were monitored with EIT.

Results:

After RMs, patient with arterial blood oxygen partial pressure (PaO₂) + carbon dioxide partial pressure (PaCO₂) >400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders. Thirteen ARDS patients was diagnosed as responders whose PaO₂ + PaCO₂ were higher than nonresponders (419 ± 44 mmHg vs. 170 ± 73 mmHg, P < 0.0001). In responders, PEEP mainly increased recruited pixels in dependent regions and over-distended pixels in nondependent regions. PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume. PEEP levels without significant alveolar derecruitment and over-distension were identified individually.

Conclusions:

After RMs, PEEP titration significantly affected regional gas distribution in lung, which could be monitored with EIT. EIT has the potential to optimize PEEP titration.     

呼吸功能锻炼在慢性阻塞性肺疾病住院患者中的治疗效果观察

目的 探讨呼吸功能锻炼在慢性阻塞性肺疾病(COPD)住院患者中的疗效。方法慢性阻塞性肺疾病患者125例按是否参加功能锻炼分为常规治疗组和功能锻炼组。常规治疗组采用常规治疗,功能锻炼组在常规治疗基础上增加呼吸功能锻炼,分析两组治疗前后血气和肺功能指标。结果两组患者治疗后,血气分析及肺功能指标均有不同程度好转,但功能锻炼组较常规治疗组,pH值、PaO₂及PaCO₂明显改善,肺功能进一步好转,C0PD评分下降。结论呼吸功能锻炼能明显改善住院慢性阻塞性肺疾病患者肺功能,提高患者生活质量。