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目的 观察无创正压通气 (NIPPV)不同压力水平对慢性阻塞性肺疾病 (COPD)患者呼吸生理参数的影响 ,为临床合理地应用NIPPV提供理论依据。方法 2 0 0 0 - 0 3～ 2 0 0 4 - 0 3广州呼吸疾病研究所对 9例急性加重期COPD患者应用NIPPV治疗 ,以 9名健康志愿者作为对照 ,分别在低吸气压力支持 (IPAP)、“最舒适”IPAP和高IPAP三个压力水平通气 15min以上 ,比较不同压力水平呼吸生理参数的改变。结果 COPD组及正常对照组最舒适的IPAP为 (13 11± 2 8)cmH2 O(1cmH2 O =0 0 98kPa)及 (11 33± 3 2 0 )cmH2 O ,呼气压力支持 (EPAP)为 (4 33± 0 5 0 )cmH2 O及 (4 5 6± 0 88)cmH2 O ,两组比较差异均无显著性 (P均 >0 0 5 )。两组受试者均提示 ,与自主呼吸相比 ,NIPPV增加分钟通气量 (VE)的同时 ,总的呼吸做功 (Wtot)明显增加 (P <0 0 5 ) ,而吸气肌做功占总的吸气做功的百分比 (Wi,p/Wi)明显减少 (P <0 0 5 )。在最舒适IPAP时 ,COPD组Wi,p/Wi降低到基础值的 (15± 14 ) %。这种变化趋势与IPAP的水平正相关。 结论 NIPPV可以显著降低急性发作期COPD患者的吸气肌肉做功。吸气肌做功减少的比例与IPAP的水平相关。
Objective To observe the effects of different pressure levels of NIPPV on respiratory parameters in patients with chronic obstructive pulmonary disease (COPD), and to provide a theoretical basis for clinical application of NIPPV. Method 2 0 0 0 - 0 3 ~ 2 0 0 4 - 0 3 Guangzhou Institute of Respiratory Diseases 9 cases of acute exacerbation of COPD patients with NIPPV treatment, nine healthy volunteers as a control, respectively, in the low suction pressure support ( IPAP), “most comfortable” IPAP and high IPAP three levels of ventilation over 15min, compared with different pressure levels changes in respiratory physiology parameters. Results The most comfortable IPAP in the COPD group and the normal control group was (13 11 ± 2 8) cmH 2 O (1 cmH 2 O = 0 0 98kPa) and (11 33 ± 3 2 0) cmH 2 O, and EPAP was 4 33 ± 0 5 0) cmH 2 O and (45 56 ± 0 88) cmH 2 O. There was no significant difference between the two groups (P> 0.05). Both groups of subjects suggested that while NIPPV increased minute ventilation (VE) and total Wtot significantly increased (P <0 05) compared with spontaneous breathing, the inspiratory muscle work performed in total The percentage of inspiratory work (Wi, p / Wi) was significantly reduced (P <0.05). At the most comfortable IPAP, Wi, p / Wi decreased to (15 ± 14)% of the baseline in the COPD group. This trend is positively correlated with the level of IPAP. Conclusion NIPPV can significantly reduce inspiratory muscle work in patients with acute exacerbation of COPD. The reduced proportion of inspiratory muscle work is related to the level of IPAP.