Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease

Objective To evaluate whether helium-oxygen mixture reduces inspiratory work of breathing (WOB) in sedated, paralyzed, and mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).Design and setting Open, prospective, randomized, crossover study in the medical intensive care unit in a university hospital.Patients and participants 23 patients admitted for acute exacerbation of COPD and mechanically ventilated.Measurements Total WOB (WOBt), elastic WOB (WOBel), resistive WOB (WOBres), and WOB due to PEEPi (WOBPeepi) were measured. Static intrinsic positive end expiratory pressure (PEEPi), static compliance (Crs), inspiratory resistance (Rins), inspiratory (tinsp) and expiratory time constant (texp) were also measured. These variables were compared between air-oxygen and helium-oxygen mixtures.Results WOBt significantly decreased with helium-oxygen (2.34±1.04 to 1.85±1.01 J/l, p<0.001). This reduction was significant for WOBel (1.02±0.61 J/l to 0.87±0.47, p<0.01), WOBPeepi (0.77±0.38 J/l to 0.54±0.38, p<0.001), and WOBres (0.55±0.19 J/l to 0.44±0.24, p<0.05). PEEPi, Rins, tinsp and texp significantly decreased. Crs was unchanged.Conclusions Helium-oxygen mixture decreases WOB in mechanically ventilated COPD patients. Helium-oxygen mixture could be useful to reduce the burden of ventilation.     

睡眠状态下的浅快呼吸指数预测慢性阻塞性肺疾病急性加重期患者撤机的研究

目的：研究睡眠状态下的浅快呼吸指数(RSBI)对慢性阻塞性肺疾病急性加重期(AECOPD)患者撤机的临床意义,探讨用排除精神因素干扰后的浅快呼吸指数指导撤机的时机。方法符合 AECOPD 机械通气指南建议撤机的患者随机分为试验组和常规组,计算不同意识状态下的 RSBI,均以<105 bpm/L 作为标准,分别予以评估撤机时机,常规组以清醒状态下测定的 RSBI 作为撤机预测指标,试验组以睡眠状态下的 RSBI 作为撤机预测指标,评估机械通气时间及撤机成功率。结果常规组与试验组在机械通气时间上分别为(9.24±3.02)天和(7.78±1.97)天,差异有统计学意义(P <0.05),撤机成功率分别达到78.7%和81.4%,差异无统计学意义(P >0.05)。结论睡眠状态下测定的 RSBI 能够避免了意识状态对撤机指标的影响,更早预测撤机时机,有效的缩短有创机械通气时间。     

Investigation of the spontaneous modes of breathing of different ventilators

We investigated six ventilator systems which were designed to allow spontaneous breathing. The time delay between initiation of inspiratory effort and the beginning of inspiratory gas flow was measured, as was the amount of negative (to ambient) pressure generated in the airway needed to produce the gas flow. We found that the flow-by program of the Puritan-Bennett 7200 caused minimal time delay and virtually no negative pressure was required to instigate gas flow. This should be contrasted with the other ventilator systems, which caused significant delay and inspiratory effort and hence increased work of breathing.     

呼吸操对慢性阻塞性肺病患者肺功能和生活质量的影响

目的 研究呼吸操对慢性阻塞性肺病(COPD)肺功能和生活质量的影响.方法 用随机、对照的设计方法观察了55例COPD患者呼吸操治疗后对肺功能和生活质量的疗效.结果 呼吸锻炼6个月后用力肺活量(FVC)由治疗前的(2.02±0.48)L提高到(2.53±0.55)L(P＜0.05);1秒用力呼气容积(FEVl)由(1.28±0.57)L提高到(1.65±0.48)L预计值(P＜0.01);FEV1/FVC由71.22±11.43提高到89.86±12.36(P＜0.01);PaO2由治疗前(56.54±4.03)mm Hg提高到(71.04±4.63)mm Hg(P＜0.01);PaCOz由(53.08±10.00)mm Hg下降到(52.11±11.05)mm Hg(P＞0.05).生活质量评分:治疗组呼吸操前总均分由(2.7±0.4)分下降到(2.1±0.4)分(P＜0.05),对照组(2.8±0.5)分上升到(3.1±0.6)分(P＜0.05).结论 呼吸操可使FVC增加,FEV1预计值增加,FEV1/FVC百分比增加,从而可以改善COPD患者的肺功能.呼吸操治疗后QOL评分下降,因而能提高生活质量;同时呼吸操治疗还可锻炼和增强患者的体力和活动能力,提高抗病能力,延缓疾病的进展,从而最终提升患者的生活质量.     

自主呼吸试验在慢性阻塞性肺病患者撤离人工气道中的作用

目的：探讨自主呼吸试验（SBT）对机械通气的慢性阻塞性肺病（COPD）患者脱离呼吸机、拔出气管插管时间的影响。方法：采用规范的SBT方法拔出气管插管的COPD患者26例（男性19例,女性7例）列入本研究,作为SBT组。回顾性分析未采用SBT方法拔出气管插管的机械通气COPD患者28 例（男性24例,女性4例）,作为No-SBT组。比较两组患者机械通气时间、拔出气管插管时间（拔管时间）,拔管后气管插管复插率（拔出气管插管48h内）心及PaO2,PaCO2血清白蛋白,血红蛋白。结果：两组患者的年龄 (P=0.683)、机械通气时间(P=0.167)差异无显著性,但是SBT组拔出气管插管的时间（60min）与No-SBT组(40—540min)比较差异有显著意义（P=0.0001）。SBT组和No-SBT组患者拔出气管插管后,需无创通气辅助的患者均为3例（P=0.717）,48h内再次气管插管患者前者为2例（2/24）,后者为3例（3/28）（P=0.900）,再次气管插管的原因均为气道分泌物排出不畅。结论：对COPD患者,在撤离呼吸机、拔出气管插管的过程中采用规范SBT方法可以明显地缩短拔管时间,而且未增加气管插管的复插率。     

Effect of PEEP on work of breathing in mechanically ventilated COPD patients

Objective: To study the effects of PEEP on the inspiratory work done per breath on the respiratory system (W_I,rs) in patients with chronic obstructive pulmonary disease (COPD).¶Design: Physiological study.¶Setting: Fourteen-bed Medical ICU of a 1000-bed teaching tertiary hospital.¶Patients and participants: Ten patients with COPD intubated and mechanically ventilated for acute respiratory failure.¶Interventions: PEEP of 0 (ZEEP), ¶5, 10, and 15 cm H₂O were applied randomly and measurements done at the end of a 15–20 min period.¶Measurements and results: Using the rapid airway occlusion technique during constant flow inflation, we partitioned W_I,rs into its static and dynamic components. On ZEEP, the mean ± SD values of W_I,rs amounted to 15.1 ± 5.7 cm H₂O × l. With increasing PEEP, W_I,rs was significantly reduced to 12.6 ± 5.7, 11.1 ± 4.1, and 10.4 ± 2.8 cm H₂O × l at PEEP of 5, 10, and 15 cm H₂O, respectively (P < 0.05). This reduction was entirely due to the decline of the work due to intrinsic PEEP (PEEPi) and was abolished when the applied PEEP counterbalanced PEEPi. The other components of W_I,rs were not affected by PEEP. By increasing PEEP up to the level of PEEPi on ZEEP, no further increase in end-expiratory lung volume was observed.¶Conclusions: In COPD patients the application of PEEP levels close to PEEPi can substantially reduce W_I,rs without promoting further dynamic pulmonary hyperinflation.     

Proportional assist versus pressure support ventilation: effects on breathing pattern and respiratory work of patients with chronic obstructive pulmonary disease

Objective: To investigate the breathing pattern and the inspiratory work of breathing (WOB_I) in patients with chronic obstructive pulmonary disease (COPD) assisted with proportional assist ventilation (PAV) and conventional pressure support ventilation (PSV). Design: Prospective controlled study. Setting: Intensive care unit of a university hospital. Patients: Thirteen COPD patients being weaned from mechanical ventilation. Interventions: All patients were breathing PSV and two different levels of PAV. Measurements and main results: During PAV (EVITA 2 prototype, Dräger, Germany), the resistance of the endotracheal tube (R_et) was completely compensated while the patients' resistive and elastic loads were compensated for by approximately 80 % and 50 % (PAV₈₀ and PAV₅₀), respectively. PSV was adjusted to match the same mean inspiratory pressure (Pinsp_mean) as during PAV₈₀. Airway pressure, esophageal pressure and gas flow were measured over a period of 5 min during each mode. Neuromuscular drive (P_0.1) was determined by inspiratory occlusions. Mean tidal volume (V_T) was not significantly different between the modes. However, the coefficient of variation of V_T was 10 ± 4.%, 20 ± 13 % and 15 ± 8 % during PSV, PAV₈₀ and PAV₅₀, respectively. Respiratory rate (RR) and minute ventilation (V_E) were significantly lower during PAV₈₀ as compared with both other modes, but the differences did not exceed 10 %. PAV₈₀ and PSV had comparable effects on WOB_I and P_0.1, whereas WOB_I and P_0.1 increased during PAV₅₀ compared with both other modes. Conclusion: Mean values of breathing pattern did not differ by a large amount between the investigated modes. However, the higher variability of V_T during PAV indicates an increased ability of the patients to control V_T in response to alterations in respiratory demand. A reduction in assist during PAV₅₀ resulted in an increase in WOB and indices of patient effort.     

慢性阻塞性肺病高碳酸血症患者增强自主呼吸后的动脉血气变化

为了观察自主呼吸增强后通气和气体代谢变化对动脉血气的影响，对７例健康志愿者和５例慢性阻塞性肺病（ＣＯＰＤ）患者进行体外膈肌起搏，对９例ＣＯＰＤ患者静脉滴注可拉明，另外９例口服阿米脱林。结果显示：综合通气和代谢两方面变化的指标△ＶＡ％／△ＶＣＯ２％能预示ＰａＣＯ２变化趋势；全部受检者中△ＶＡ％／△ＶＣＯ２％＞１者２２例，除１例外ＰａＣＯ２均降低；而△ＶＡ％／△ＶＣＯ２％＜１的７例中ＰａＣＯ２增高５例，降低２例；健康志愿者△ＶＣＯ２／△ＶＡ均＜３０ｍｌ／Ｌ，而ＣＯＰＤ患者则大都＞３０ｍｌ／Ｌ。说明ＣＯＰＤ患者增强自主呼吸时机体代谢增强削弱了肺泡通气增加的效果；口服阿米脱林组ＰａＯ２增高较ＰａＣＯ２降低明显，提示阿米脱林除增强通气以外，还能改善换气功能，使ＰａＯ２进一步提高     

Effect of low-level PEEP on inspiratory work of breathing in intubated patients,both with healthy lungs and with COPD

Objective Evaluation of low-level PEEP (5 cm H₂O) and the two different CPAP trigger modes in the Bennett 7200a ventilator (demand-valve and flow-by trigger modes) on inspiratory work of breathing (W_i) during the weaning phase.Design Prospective controlled study.Setting The intensive care unit of a university hospital.Patients Six intubated patients with normal lung function (NL), ventilated because of non-pulmonary trauma or post-operative stay in the ICU, and six patients recovering from acute respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD), breathing either FB-CPAP or DV-CPAP with the Bennett 7200a ventilator.Interventions The patients studied were breathing with zero end-expiratory pressure (ZEEP), as well as CPAP of 5 cm H₂O (PEEP), with the following respiratory modes: the demand-valve trigger mode, pressure support of 5 cm H₂O, and the flow-by trigger mode (base flow of 20 l/min and flow trigger of 2 l/min). Furthermore, W_i during T-piece breathing was evaluated.Measurements and results W_i was determined using a modified Campbell's diagram. Total inspiratory work (W_i), work against flow-resistive resistance (W_ires), work against elastic resistance (W_iel), work imposed by the ventilator system (W_imp), dynamic intrinsic positive end-expiratory pressure (PEEP_idyn), airway pressure decrease during beginning inspiration (P_aw) and spirometric parameters were measured. In the NL group, only minor, clinically irrelevant changes in the measured variables were detected. In the COPD group, in contrast, PEEP reduced W_i and its components W_ires and W_iel significantly compared to the corresponding ZEEP settings. This was due mainly to a significant decrease in PEEP_idyn when external PEEP was applied. Flow-by imposed less W_i on the COPD patients during PEEP than did demand-valve CPAP. Differences in W_imp between the flow-by and demand-valve trigger models were significant for both groups. However, in relation to W_i these differences were small.Conclusion We conclude that the application of low-level external PEEP benefits COPD patients because it reduces inspiratory work, mainly by lowering the inspiratory threshold represented by PEEP_idyn. Differences between the trigger modes of the ventilator used in this study were small and can be compensated for by the application of a small amount of pressure support.Supported by Deutsche Forschungsgemeinschaft SFB 330 Organprotektion Project B17     

Chronic heart failure modifies the response to positive end-expiratory pressure in patients with chronic obstructive pulmonary disease

Introduction

Potentially beneficial effects of positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) must be balanced against further overinflation and increased alveolar dead space. Concurrent chronic heart failure (CHF) is common and can lead to changes in lung that can reduce the detrimental effects of PEEP.

Objective

The aim of this study was to compare the effect of PEEP on volumetric capnography, blood gases, pulmonary mechanics, and vital signs in subjects with either COPD (n = 13) or COPD + CHF (n = 7) during pressure support ventilation.

Methods

Positive end-expiratory pressure was administered at 0, 5, 10, 15, and 0 cm H₂O for 15 minutes with pressure support maintained at 10 cm H₂O. Data are expressed as mean ± SD, and the effect of PEEP and differences between COPD alone and COPD + CHF were tested with repeated-measures analysis of variance.

Results

Subjects were elderly (72.5 ± 13.3 years) with severe COPD (force expired volume in 1 second, 1.3 ± 0.6L; force expired volume in 1 second/force vital capacity, 40% ± 15%). With increasing PEEP in COPD subjects, dead space ratio increased (P < .001), minute alveolar ventilation decreased (P = .001), and Paco₂ increased (P = .013), with no change in COPD + CHF subjects. Subjects with COPD + CHF had improvement in Pao₂ and lower mean arterial pressure, whereas both were unchanged in subjects with COPD alone.

Conclusion

In subjects with severe COPD alone, caution must be used when administering PEEP 10 cm H₂O or greater. Subjects with COPD + CHF may benefit from higher levels of PEEP.     

以改良格拉斯哥昏迷评分15分为切换点在有创-无创机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭中的应用

目的 探讨以改良格拉斯哥昏迷评分(GCS)15分为切换点指导慢性阻塞性肺疾病(COPD)合并呼吸衰竭(呼衰)患者早期拔管改换无创机械通气的可行性,并评价其治疗效果.方法 选择接受气管插管和机械通气的COPD并呼衰患者,采用前瞻性对照研究方法,以2007年3月至2009年11月收治的20例患者为治疗组,采用同步间歇指令通气+压力支持通气(SIMV+PSV)方式行机械通气,待改良GCS评分达15分并稳定2 h的窗口期拔除气管导管,改用经鼻面罩PSV+呼气末正压(PEEP)通气,以后逐渐减小压力支持(PS)水平直至脱机;以2005年3月至2007年3月收治的19例患者为对照组,按常规机械通气及传统脱机方式脱机.动态观察两组患者机械通气前通气及氧合指标,接受有创机械通气时间、总机械通气时间、总住院时间、再插管及呼吸机相关性肺炎(VAP)发生例数.结果 两组机械通气前通气及氧合指标均无明显差异.治疗组较对照组有创通气时间(d:3.2±1.1比10.5±3.2)、总机械通气时间(d:4.8±2.5比10.5±3.2)、总住院时间(d:17±3比22±7)均明显缩短(均P＜0.01);VAP发生数减少(例:0比5,P＜0.01),再插管数稍增加,但无统计学意义(例:3比1,P＞0.05).结论 对COPD合并呼衰的机械通气患者,以改良GCS评分达15分稳定2 h窗口期为时机早期拔管改用经鼻面罩无创通气,可以显著改善患者的治疗效果.

Abstract：

Objective To estimate the feasibility and the efficacy of early extubation and the sequential non-invasive mechanical ventilation (MV) in severe respiratory failure of chronic obstructive pulmonary disease (COPD) with the improved Glasgow coma scale (GCS) score of 15 as the switching point. Methods By a prospective control study, 20 patients with COPD and respiratory failure who had undergone endotracheal intubation and MV from March 2007 to November 2009 were enrolled as treatment group.Invasive MV with synchronous intermittent mandatory ventilation and pressure support ventilation (SIMV+PSV) pattern were given to these patients. When the period of "improved GCS score of 15 standard" window period appeared and being kept for 2 hours, endotracheal tube was extubated, and nasal mask with PSV±positive end-expiratory pressure (PEEP) was used, followed by gradual decrease of the level of pressure support till weaning of MV. Nineteen patients who were treated with MV with ordinary way of weaning from March 2005 to March 2007 served as the control group. Prior to the MV, the ventilation and oxygenation index, the length of invasive MV, total MV time, total hospital stay, re-intubation and ventilator-associated pneumonia (VAP) occurred in the number of cases were observed and compared between two groups. Results There was no significant difference in the ventilation and oxygenation index prior to the MV. Compared with control group, in treatment group, the length of invasive ventilation (days: 3. 2±1.1 vs. 10. 5± 3. 2),the total duration of MV (days: 4. 8±2. 5 vs. 10. 5±3. 2), the length of hospital stay (days:17±3 vs. 22±7) were significantly shorter (all P＜0.01), and the incidence of VAP was significantly lower (cases: 0 vs.5, P＜ 0. 01), while the number of re-intubation was slightly higher but without statistical significance (cases:3 vs. 1, P＞0. 05). Conclusion The application of improved GCS score of 15 as the switching point with 2 hours as window period for early extubation and non-invasive nasal mask ventilation can significantly improve the therapeutic effect in patients with severe respiratory failure in COPD.     

应用皮格马利翁效应提高慢性阻塞性肺病患者呼吸功能锻炼的依从性

目的探讨应用皮格马利翁效应提高慢性阻塞性肺病患者呼吸功能锻炼的依从性效果。方法将105例慢性阻塞性肺病患者按住院号尾数奇数、偶数分组,观察组46例,对照组59例;对照组给予常规呼吸功能锻炼指导,观察组应用皮格马利翁效应实施呼吸功能锻炼指导;观察两组住院期间平均每次锻炼时间、锻炼时每分钟呼吸次数及出院1月时呼吸功能锻炼坚持率。结果观察组每次锻炼平均时间较对照组长、锻炼时每分钟呼吸次数较对照组少、出院1月时呼吸功能锻炼坚持率较对照组高,差异比较有统计学意义。结论应用皮格马利翁效应能提高慢性阻塞性肺病患者呼吸功能锻炼的依从性。     

The pathophysiology of emphysema: Considerations for critical care nursing practice

Emphysema is caused by exposure to cigarette smoking as well as alpha(1)-antitrypsin deficiency. It has been estimated to cost the National Health Service (NHS) in excess of 800 million pounds per year in related health care costs. The challenges for Critical Care nurses are those associated with dynamic hyperinflation, Auto-PEEP, malnutrition and the weaning from invasive and non-invasive mechanical ventilation. In this paper we consider the impact of the pathophysiology of emphysema, its effects on other body systems as well as the impact acute exacerbations have when patients are admitted to the Intensive Care Unit.     

家庭氧疗配合呼吸操对慢性阻塞性肺疾病患者预后的影响

目的:观察家庭氧疗配合呼吸操对慢性阻塞性肺疾病患者肺功能、生存质量及急性发作次数的影响。方法:干预组及对照组各30例患者,观察时间为1年。干预组由医务人员指导进行家庭氧疗配合呼吸操训练,两组均在出院前和出院后6个月、1年检测肺功能和生存质量,同时通过电话、复诊、上门随访等方法随访1年,记录患者病情变化情况。结果:经1年干预后,干预组的肺功能、生存质量、急性加重及再次住院的频率与干预前和对照组比较有明显改善,差异具有显著性意义(P<0.05)。结论:家庭氧疗配合呼吸操康复治疗,能改善患者肺功能,延缓肺功能进一步恶化,提高患者的生存质量,改善预后,值得推广。     

不同雾化吸入方法对慢性阻塞性肺疾病病人影响的研究

目的 观察3种雾化吸入方法对慢性阻塞性肺疾病（COPD）病人动脉血气分析及临床症状的影响。方法 将90例COPD病人分为3组，每组30例，用相同剂量的异丙托溴铵，分别采用空气压缩（A组）、高流量氧气（B组）及低流量氧气（C组）雾化吸入，雾化吸入前后分别采集动脉血气分析，同时观察病人临床症状的变化。结果 3组雾化吸入前后比较，pH及PaCO2无显著性差异（P〉0．05）。PaO2及SaO2A组显著降低（P〈0．01），而B、C组显著升高（P〈0．01）。临床症状加重的病人数A组多于B组（P〈0．05），A组显著多于C组（P〈0．01）。结论 氧气雾化优于空气压缩雾化，而低流量氧气雾化优于高流量氧气雾化，是COPD病人安全的雾化吸入方法。     

慢性阻塞性肺疾病患者两种雾化吸入疗法的临床效果对比研究

目的 比较两种雾化吸入疗法对慢性阻塞性肺疾病(COPD)患者动脉血气分析及临床症状体征的影响.方法 将90例COPD患者随机分为压缩组和氧驱组各45例,用相同剂量的硫酸沙丁胺醇雾化吸入溶液加生理盐水,分别采用压缩空气雾化吸入和氧驱雾化吸入,雾化吸入前后分别抽取动脉血行血气分析检查,同时监测患者临床症状体征的变化.结果 两组患者雾化吸入前后比较,Pa02值及Sa02值均升高,两组同期比较无显著性差异(P ＞0.05);PaC02值,压缩空气吸入组降低(P＜0.05),而氧驱雾化吸入组无明显变化(P＞0.05),两组同期比较有显著性差异(P＜0.05);两组雾化吸人后临床症状体征比较,差异无显著性意义(P＞0.05).结论 压缩空气雾化吸入及氧驱雾化吸入均适用于COPD患者,但对于COPD合并Ⅱ型呼吸衰竭的患者,压缩空气雾化吸入疗法优于氧驱雾化吸入.     

慢性阻塞性肺病患者肺功能和生活质量的研究

对５６例慢性阻塞性肺疾病患者进行肺通气功能测定和生活质量评估，结果显示反映气道阻塞程度的指标第１秒用力呼气容积占预计值百分比及第１秒用力呼气容积／用力肺活量与生活质量总均分的相关性均有统计学意义。     

呼吸训练对缓解期老年重度COPD患者生存质量及日常生活活动的影响

目的：探讨呼吸训练对缓解期老年重度慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者的生存质量及日常生活活动的影响.方法：选择缓解期老年重度COPD患者30例,随机分为对照组10例,呼吸训练组20例.对照组常规内科治疗,呼吸训练组除常规内科治疗外采用缩唇呼吸和腹式呼吸训练3个月.呼吸训练前后分别评价生存质量（QOL）和日常生活活动（ADL）,同时测定肺功能和呼吸次数/分钟,与非训练组及训练前进行比较.结果：尽管呼吸训练组呼吸训练后与对照组及与训练前比较肺功能和ADL均无明显差异,但呼吸训练组呼吸频率与训练前比较明显降低（P＜0.05）,与对照组比较呼吸频率明显降低（P＜0.01）,呼吸短促症状明显减轻（P＜0.05）,QOL部分提高.结论：①生存质量指标中呼吸短促症状评价,结合呼吸次数/分钟评估呼吸康复效果较好;②即使是老年严重的COPD患者,也能通过呼吸训练使他们在生存质量上得到改善,呼吸康复适用于所有COPD患者.     

团队式授权教育在老年慢性阻塞性肺疾病患者呼吸功能锻炼中的应用效果

目的：探讨团队式授权教育在老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者呼吸功能锻炼中的应用及效果。方法 选取100例老年COPD患者,随机分为观察组和对照组,每组50例。对照组给予常规健康教育,观察组给予团队式授权教育。比较两组自我效能、呼吸功能锻炼依从性及肺功能指标（VC、FEV1及FEV1/FVC）。结果：干预后,观察组自我效能评分高于对照组（P＜0.05）;观察组服药依从性、肺功能指标（VC、FEV1、FEV1/FVC）均优于对照组（P＜0.05）。结论：实施团体授权教育,有利于提高老年COPD患者自我效能及服药依从性,并改善其肺功能。     

应变和应变率成像对慢性阻塞性肺病患者右室收缩功能的评价

目的 探讨应变和应变率成像评估慢性阻塞性肺病（COPD）患者右室心肌收缩功能的价值.方法 根据肺动脉收缩压将38例COPD患者分为肺动脉高压组（病例组Ⅰ）和无肺动脉高压组（病例组Ⅱ）,同期正常对照组为18例健康体检者.使用M型超声和常规超声测量右室前壁舒张末期厚度（RVFT）、右室舒张末期内径（RVEDd）、三尖瓣环收缩期位移（TAPSE）、右室舒张末期面积（RVEDa）及右室收缩末期面积（RVESa）,计算右室面积变化分数（RVFA）.采用应变和应变率分析软件检测右室游离壁和室间隔各节段的收缩期峰值应变（Ss）和收缩期峰值应变率（SRs）.结果 与正常对照组比较,病例组Ⅰ的RVFT增厚,RVEDd明显增大,RAFA和TAPSE明显减小（P＜0.05）,病例组Ⅱ的上述参数与正常对照组比较差异无统计学意义（P＞0.05）.病例组Ⅰ右室游离壁、室间隔基底段、中间段的Ss和SRs均显著低于病例组Ⅱ和正常对照组（P＜0.05）,病例组Ⅱ的右室游离壁基底段的Ss和SRs均显著低于正常对照组（P＜0.05）.结论 应变和应变率成像能有效检出COPD患者早期右室局部心肌收缩功能变化,以右室游离壁基底段Ss与SRs的变化较为敏感.