摘要
目的 :比较分析容量控制通气中减速波、恒速波 (方形波 )及正弦波 3种吸气流速波型对慢性阻塞性肺疾病 (COPD)患者肺生理如呼吸力学及气体交换的影响。方法 :18名经鼻或经口气管插管连接呼吸机进行容量控制通气的COPD患者 ,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 ,同时进行床头肺功监测。同时测定动脉血气并记录心率、血压、Pa -etCO2 等指标。结果 :(1)血气 :在峰流速一定时 ,恒速波时PaCO2 与减速波相比显著降低 (P <0 .0 5) ,而在吸呼比一定时PaCO2 无差异。两种情况下PaO2 、心率、平均动脉压、Pa-etCO2 均无差异 (P >0 .0 5)。(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 .0 5) ;食道压波动、气道平均阻力减速波最小 ,恒速波最大 (P <0 .0 5) ;呼吸机做功三者之间无显著差别。结论 :3种不同的吸气流速波型 (减速波、恒速波、正弦波 )对COPD患者动脉血气分析及呼吸力学均存在不同效应。减速吸气流速波型可以降低气道阻力 ,减速波时气道峰压较低 ,可以减少气压伤的发生 ,但减速波时平均气道压较高 。
Objective: To investigate the effects of d if ferent inspiratory flow waveforms, that is, constant, decelerating, and sinusoid al in volume controlled ventilation on pulmonary physiology of patients with chr onic obstructive pulmonary disease(COPD). Methods: Eighteen pa tients with severe COPD receivedvolume controlled mechanical ventilation, Bico re cp-100 pulmonary monitor providing continuous pulmonary monitoring at the be dside.The inspiratory flow waveforms changed randomly, but the tidal volume, res piratory rate, FiO 2 kept constant . We measured arterial blood gases, airway p ressure, esophageal pressure, compliance, respiratory work, heart rate, blood pr essure, and P et CO 2 with constant I/E or peak flow. Results:(1) Arterial oxygen tension (PaO 2) was not affected by changes i n the inspiratory flow waveforms; while arterial carbon dioxide tension (PaC O 2) decreased obviously in constant flow waveform compared with that in decele rating flow waveform with constant peak flow. (2) With constant I/E or with cons tant peak flow, peak airway pressure, delta esophageal pressure, mean airway res istance, and expiratory airway resistance were all highest in constant flow wave form and lowest in decelerating flow waveform. While mean airway pressure and dy namic compliance were highest in decelerating flow waveform and lowest in consta nt flow waveform. Ventilator work, heart rate, and mean arterial blood pressurewere not affected by different inspiratory flow waveforms. Conclusion:The ventilator inspiratory flow waveforms can influence not only arteri al carbon dioxide tension but also respiratory mechanics, but have no impact onarterial oxygen tension in COPD patients receiving volume controlled ventilation .
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2004年第1期42-44,47,共4页
Journal of China Medical University
基金
教育部高等学校骨干教师基金资助项目 (教技司 [2 0 0 0 \〗6 5号 )
关键词
慢性阻塞性肺疾病
吸气流速波型
容量控制通气
chronic obstructive pulmonary disease
inspirat ory flow waveform
volume controlled ventilation
