慢性阻塞性肺疾病机械通气治疗中外源性呼气末正压的设置

目的 探讨适合慢性阻塞性肺疾病(COPD)患者的外源性呼气末正压(PEEPe)的设置范围.方法 明确诊断为COPD合并Ⅱ型呼吸衰竭需行机械通气治疗的患者36例,按PEEPe为0时的内源性呼气末正压(PEEPi)的40%(40%PEEPi组)、50%(50%PEEPi组)、60%(60%PEEPi组)、70%(70%PEEPi组)、80%(80%PEEPi组)、90 %(90%PEEPi组)和100%(100%PEEPi组)设置PEEPe,监测呼吸力学、血流动力学和动脉血气变化.结果 随着PEEPe的升高,呼吸功下降,呼吸机做功升高,60%、70%、80%、90%和100%PEEPi组与基础值的差异均有统计学意义(P值均＜0.05).食管压差随PEEPe的升高而下降,70%、80%、90%和100%PEEPi组与基础值比较差异均有统计学意义(P值均＜0.05).气道峰压、平台压随PEEPe的升高而升高,60%、70%、80%、90%和100%PEEPi组与基础值的差异均有统计学意义(P值均＜0.05),100%PEEPi组与60%PEEPi组的差异也有统计学意义(P＜0.05).心输出量和心指数随PEEPe的升高而下降,90%、100%PEEPi组与基础值的差异均有统计学意义(P值均＜0.05).结论 将PEEPe设置在PEEPe为0时所测得PEEPi的60%～80%范围内.可减少患者所做呼吸功,提高机械通气效率,改善呼吸系统顺应性,且对循环系统的抑制作用小.是适合COPD患者的PEEPe设置范围.

Proper extrinsic positive end-expiratory pressure during mechanical ventilation in patients with chronic obstructive pulmonary disease

Objective To discuss the proper range of extrinsic positive end-expiratory pressure (PEEPe) during mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD). Methods Thirty-six ventilated patients with confirmed COPD were included in the present study. Dynamic intrinsic positive end-expiratory pressure (PEEPi),work of breathing patient (WOBp),work of breathing ventilation (WOBv),difference of esophagus pressure (dPes),tidal volume (Vt),peak pressure (Ppeak),plateau pressure (Pplat...