摘要
目的 比较分析减速波、恒速波(方形波)及正弦波吸气流速波型对容量控制通气(CMV)慢性阻塞性肺疾病(COPD)患者呼吸力学及气体交换的影响。方法 18例COPD患者经鼻或经口气管插管连接PB7200呼吸机进行容量控制通气,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,用Bicore-CP100进行床头肺功能监测。同时测定动脉血气并记录当时心率、血压、PetCO_2。结果 (1)血气:在一定峰流速时,恒速波与减速波相比PaCO_2显著降低(P<0.05),在吸呼比一定时,两种波型的PaCO_2无差异。两种波型下PaO_2均无差异,心率、平均动脉压、Pa-etCO_2亦无差别(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);呼吸机作功(WOBv)三者之间亦无显著差别。结论 对于COPD上机患者,减速波、恒速波及正弦波三种吸气流速波型对动脉血气分析及呼吸力学均存在不同效应。
Objective The aim of this study is to investigate the effects of different inspiratory flow waveforms,i.e.constant,decelerating and sinusoidal,on arterial blood gases and respiratory mechanics, in COPD patients with mechanical ventilated. Methods 18 patients with severe COPD during volume-control mechanical ventilation were studied,and the Bicore CP-100 pulmonary monitor was employed offered continuous pulmonary monitoring at the bedside.The PB 7200 ventilator inspiratory flow waveform was changed according to a randomized sequence, keeping constant tidal volume, respiratory rate , FiO2,etc. Arterial blood gases,airway pressure, esophageal pressure, compliance, respiratory work, heart rate,blood pressure and PetCO2 were measured while I/E and peak flow kept constant. Results (1) Arterial oxygen tension(PaO2) was not affected by changes in the inspiratory flow waveform while arterial carbon dioxide tension(PaCO2) decreased obviously in constant flow waveform comparing with decelerating flow waveform under peak flow constant condition; (2)Peak airway pressure, delta esophageal pressure, mean airway resistance and expiratory airway resistance were highest with constant flow waveform, lowest with decelerating flow waveform while mean airway pressure and dynamic compliance were highest with decelerating flow waveform, lowest with constant flow waveform. Ventilator work, heart rate and mean arterial blood pressure were not affected by different inspiratory flow waveforms.Conclusions It can be concluded from the above that the ventilator inspiratory flow waveform can influence not only arterial carbon dioxide tension but also respiratory mechanics,but has no impact on arterial oxygen tension in mechanical ventilated COPD patients.
出处
《中国呼吸与危重监护杂志》
CAS
2002年第4期210-214,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
教育部<高等学校骨干教师资助计划>资助项目
