无创正压机械的通气对慢性阻塞性肺疾病患者膈肌功能影响

目的：探索与评估膈肌功能测定对重度慢性阻塞性肺疾病（COPD）急性加重期患者无创正压机械通气（NPPV）疗效的意义。方法：选择住院的急性加重期COPD患者28例，施行常规治疗＋NPPV。分别记录无创通气前，通气后48小时、终止无创通气前的跨膈压（Pdi），肺功能、动脉血气，同时综合评估通气前、后的支气管-肺部感染情况。结果：1、无创通气治疗成功组：通气后Pdi,第一秒用力呼气容积（FEV1）．动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、pH值分别为（14．04±2．40）cmH2O、（0．70±0.24）L、（48．2±4．2）mmHg．（70．0±6．3）mmHg、（7．37±0．05），与通气前（（10．98±0．45）cmH20、（0．59±0．11）L、（68．2±10．2）mmHg、（52．5±6．1）mmHg、（7．34±0．06））比较差异均有统计学意义（P均〈0．05）。2、开创通气治疗失败者：2例。1例其Pdi在通气前为8．74cmH2O，通气48小时为9．24cmH2O；另1势9Pdi，通气前为7，56cmH2O,结论：在NPPV治疗过程中，Pdi和EIIFEV1．PaCO2、PaO2、pH值的变化有高度一致性，Pdi的动态变化．可以客观地反映膈肌的功能状态；NPPV有助手改善AECOPD患者的膈肌功能。

The Efficacy of Noninvasive Positive Pressure Ventilation in Patients with Chronic Obstructive Pulmonary Disease through Assessing Diaphragmatic Muscle Function

Objective： To evaluate the efficacy of noninvasive positive pressure ventilation c NPPV） in acute patients with Chronic Obstructive Pulmonary Disease （COPD）through assessing diaphragmatic muscle function. Methods： 28 cases of COPD with exacerbation were selected with conventional therapy together with NPPV. Parameters before NPPV, 48 hours after and finishing NPPV were compared. In which, it was included that transdiaphragmatic pressure（Pdi）, lung function test, arterial blood gases and pulmonary infection before and finishing NPPV. Results： By finishing NPPV, the difference of the Pdi, FEV1,PaCO2, PaO2and pH （（14.04±2.40） cmH2O, （0.70±0.24） L, （48.2±4.2） mmHg, （70.0±6.3） mmHg, （7.37±0.05）） were statistically significant compared to that before NPPV （C10.98±0.45） cmH2O, （0.59±0.11） L, （68.2±10.2） mmHg, （52.5±6.1） mmHg, （7.34±0.06）） （all P〈0.05） in success cases. 2 cases were failure with NPPV. In the first one,Pdi was 8.74cmH2O before NPPV. It rose to 9.24 cmH2O after 48 hours with NPPV.ln the second patient, Pdi was 7.56 cmH2O before NPPV, he was not adapted to NPPV. Conclusion： During NPPV, there was a high consistence between the Pdi,FEV1,PaCO2,PaO2 and pH. Dynamic changing of Pdi, can reflect the function of diaphragm objectively. On the other side, NPPV showed up its effect by the improvement of Pdi.