慢性阻塞性肺疾病患者輔助機械通氣時呼氣末正壓水平對呼氣末肺容量的影響_《中國呼吸與危重監護雜志》

作者：

秦朝輝 ¹ ,  陳榮昌 ² , 鐘南山 ²

1 煙臺毓璜頂醫院呼吸科（山東煙臺 264001）;;
2 廣州醫學院第一附屬醫院廣州呼吸疾病研究所;

關鍵詞：

慢性阻塞性肺疾病呼氣末正壓肺容量

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目的探討慢性阻塞性肺疾病（COPD）輔助機械通氣時呼氣末正壓（PEEP）水平對呼氣末肺容量（EELV）的影響規律，為臨床合理設定PEEP水平提供依據。方法 8例因COPD急性加重（AECOPD）進行插管通氣治療后病情相對穩定的病人，用呼氣末阻斷法和食道囊管法分別檢測靜態內源性呼氣末正壓（PEEPi，stat）和動態內源性呼氣末正壓（PEEPidyn），用最大深吸氣量（IC）法檢測EELV的變化（ΔEELV），用參數估計法分析PEEP與ΔEELV的關系。結果隨著PEEP的增加，ΔEELV呈S型曲線變化規律。采用最大斜率分析方法，尋找S型曲線陡直上升段起始點，分別是PEEP/PEEPistat=0.74，PEEP/PEEPidyn=0.76，相當于PEEP實際值為3.6 cm H2O；對應的ΔEELV/IC（%）分別為9.6%，9.1%和7.4%。結論對于實施機械通氣的AECOPD患者，PEEP水平增加與ΔEELV呈S型曲線變化規律，按照PEEPistat的0.74或PEEPidyn的0.76設定PEEP水平，可以避免出現ΔEELV陡直上升。

引用本文： 秦朝輝,陳榮昌,鐘南山. 慢性阻塞性肺疾病患者輔助機械通氣時呼氣末正壓水平對呼氣末肺容量的影響. 中國呼吸與危重監護雜志, 2007, 6(1): 23-26. doi: 復制

1.	俞森洋，主編.現代機械通氣的監護和臨床應用.北京：中國協和醫科大學出版社，2000.175-191.
2.	Haluszka J，Chartrand DA，Grassino AE，et al.Intrinsic PEEP and arterial PCO2 in stable patients with chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：1194-1197.
3.	秦朝輝，陳榮昌，鐘南山.慢性阻塞性肺疾病內源性呼氣末正壓的生理學效應及臨床對策.中國呼吸與危重監護雜志，2004，3：126-128.
4.	Rossi A，Brandolese R，Milic-Emili J，et al.The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation.Eur Respir J，1990，3：818-822.
5.	Ranieri VM，Giuliani R，Cinnella G，et al.Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation.Am Rev Respir Dis，1993，147：5-13.
6.	Georgopoulos D，Giannouli E，Patakas D.Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.Intensive Care Med，1993，19：197-203.
7.	Guerin C，Milic-Emili J，Fournier G.Effect of PEEP on work of breathing in mechanically ventilated COPD patient.Intensive Care Med，2000，26：1207-1214.
8.	O’Donoghue FJ，Catcheside PG，Jordan AS，et al.Effect of CPAP on intrinsic PEEP，inspiratory effort，and lung volume in severe stable COPD.Thorax，2002，57：533-539.
9.	Appendini L，Purro A，Patessio A，et al.Partitioning of inspiratory muscle workload and pressure assistance in ventilator-dependent COPD patients.Am J Respir Crit Care Med，1996，154：1301-1309.
10.	Appendini L，Patessio A，Zanaboni S，et al.Physiologic effect of positive end-expiratory pressure and mask pressure support exacerbation of chronic obstructive pulmonary disease.Am J Respir Crit Care Med，1994，149：1069-1076.
11.	Nava S，Bruschi C，Rubini F，et al.Respiratory response and inspiratory effort during pressure support ventilation in COPD patients.Intensive Care Med，1995，21：871-879.
12.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南.中華內科雜志，2002，41：640-646.
13.	Maltais F，Reissmann H，Navalesi P，et al.Comparison of static and dynamic measurement of intrinsic PEEP in mechanically ventilated patients.Am J Respir Crit Care Med，1994，150：1318-1324.
14.	Petrof BJ，Legare M，Goldberg P，et al.Continuos positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：281-289.
15.	Sydow M，Golisch W，Buscher H，et al.Effect of low-level PEEP on inspiratory work of breathing in intubated patients，both with healthy lungs and with COPD.Intensive Care Med，1995，21：887-895.
16.	Zakynthinos SG，Vassilakopoulos T，Zakynthinos E，et al.Correcting static intrinsic positive end-expiratory pressure for expiratory muscle contraction：Validation of a new method.Am J Respir Crit Care Med，1999，160：785-790.

1. 俞森洋，主編.現代機械通氣的監護和臨床應用.北京：中國協和醫科大學出版社，2000.175-191.
2. Haluszka J，Chartrand DA，Grassino AE，et al.Intrinsic PEEP and arterial PCO2 in stable patients with chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：1194-1197.
3. 秦朝輝，陳榮昌，鐘南山.慢性阻塞性肺疾病內源性呼氣末正壓的生理學效應及臨床對策.中國呼吸與危重監護雜志，2004，3：126-128.
4. Rossi A，Brandolese R，Milic-Emili J，et al.The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation.Eur Respir J，1990，3：818-822.
5. Ranieri VM，Giuliani R，Cinnella G，et al.Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation.Am Rev Respir Dis，1993，147：5-13.
6. Georgopoulos D，Giannouli E，Patakas D.Effects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.Intensive Care Med，1993，19：197-203.
7. Guerin C，Milic-Emili J，Fournier G.Effect of PEEP on work of breathing in mechanically ventilated COPD patient.Intensive Care Med，2000，26：1207-1214.
8. O’Donoghue FJ，Catcheside PG，Jordan AS，et al.Effect of CPAP on intrinsic PEEP，inspiratory effort，and lung volume in severe stable COPD.Thorax，2002，57：533-539.
9. Appendini L，Purro A，Patessio A，et al.Partitioning of inspiratory muscle workload and pressure assistance in ventilator-dependent COPD patients.Am J Respir Crit Care Med，1996，154：1301-1309.
10. Appendini L，Patessio A，Zanaboni S，et al.Physiologic effect of positive end-expiratory pressure and mask pressure support exacerbation of chronic obstructive pulmonary disease.Am J Respir Crit Care Med，1994，149：1069-1076.
11. Nava S，Bruschi C，Rubini F，et al.Respiratory response and inspiratory effort during pressure support ventilation in COPD patients.Intensive Care Med，1995，21：871-879.
12. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組.慢性阻塞性肺疾病診治指南.中華內科雜志，2002，41：640-646.
13. Maltais F，Reissmann H，Navalesi P，et al.Comparison of static and dynamic measurement of intrinsic PEEP in mechanically ventilated patients.Am J Respir Crit Care Med，1994，150：1318-1324.
14. Petrof BJ，Legare M，Goldberg P，et al.Continuos positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease.Am Rev Respir Dis，1990，141：281-289.
15. Sydow M，Golisch W，Buscher H，et al.Effect of low-level PEEP on inspiratory work of breathing in intubated patients，both with healthy lungs and with COPD.Intensive Care Med，1995，21：887-895.
16. Zakynthinos SG，Vassilakopoulos T，Zakynthinos E，et al.Correcting static intrinsic positive end-expiratory pressure for expiratory muscle contraction：Validation of a new method.Am J Respir Crit Care Med，1999，160：785-790.

《中國呼吸與危重監護雜志》

慢性阻塞性肺疾病患者輔助機械通氣時呼氣末正壓水平對呼氣末肺容量的影響

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《中國呼吸與危重監護雜志》

慢性阻塞性肺疾病患者輔助機械通氣時呼氣末正壓水平對呼氣末肺容量的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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