摘要
目的探讨不同水平的呼气末正压(PEEP)对COPD并呼吸衰竭患者病情的影响。方法选择2007年10月至2009年2月确诊为COPD并呼吸衰竭需机械通气治疗的患者40例,随机分为A组(20例,PEEP 5 cm H2O),B组(20例,PEEP10cm H2O)。监测两组患者呼吸支持后动脉血气、气道压力、血流动力学的变化。结果(1)动脉血气:两组患者上机后0.5 h、24h动脉血气指标分别比较无差异,P>0.05。(2)气道压力:上机后0.5 h、24 h B组气道峰压、气道平台压较A组明显升高,P<0.05。(3)血流动力学:上机后0.5 h、24 h A、B两组患者的心率、平均动脉压、外周循环阻力指数变化无差异,P>0.05;上机后0.5 h A、B两组患者心排血量指数、左心做功指数、胸液水平变化无差异;但上机24 h后B组上述3个指标较A组下降,P<0.05。结论COPD并呼吸衰竭患者机械通气治疗时低水平PEEP是有益且安全的;避免高水平的PEEP给患者带来负面效应。
Objective To study the effects of different level of PEEP on chronic obstructive pulmonary complication of respiratory failure. Methods 40 patients with exacerbated COPD who required mechanical ventilation because of complication of respiratory failure were studied from November 2007 to February 2009. All of the patients were randomly divided into two groups ： A group （20 eases, PEEP was set 5cm H2O） and B group （20 eases, PEEP was set 10cm H2O）. The indexes of arterial blood gas analysis, pressure and hemedy-narnies were measured after mechanical ventilation. Results（1） Arterial blood gas analysis： the indexes of arterial blood gas analysis showed no significant group difference at 0.5 h after ventilation, and at 24 h after ventilation） in two groups patients, P 〉 0.05. （2） Air-way pressure： after ventilation of 0.5h, 24h, and peak inspiratory pressure, the plateau pressure in B group was significantly higher than that in A group,P 〈0.05. （3） Hemedynamics： heart rate（HR）, mean arterial blood pressure（MAP）, systemic vascular resistance index（SVRI）, cardiac output index（CI）, left cardiac work index （LCWI）, thoracic fluid conten（TFC） didn＇t change markedly after the ventilation of 0.5h in the two groups; HR, MAP, SVRI also didn＇t change markedly after ventilation of 24 h in the two groups. However, at 24 h after ventilation CI, TFC, LCWI in B group were less than those in A group, P 〈 0.05. Conculsion Low levels of PEEP is helpful and safe to patients with COPD during mechanical ventilation. We should avoid negative effects with high level PEEP.
出处
《临床肺科杂志》
2009年第12期1596-1597,共2页
Journal of Clinical Pulmonary Medicine
关键词
慢性阻塞性肺病
呼气末正压
内源性呼气末正压
chronic obstructive pulmonary disease
positive end-expiratory pressure
intrinsic positive end-expiratory pressure
