稳定期重度高碳酸血症慢性阻塞性肺疾病患者的反馈控制负压通气

Feedback-controlled negative pressure ventilation in patients with stable severe hypercapnic chronic obstructive pulmonary disease.

作者信息

Kössler W, Lahrmann H, Brath H, Wei T, Frank W, Wild M, Zwick H, Wanke T

机构信息

Ludwig Boltzmann Institute for Environmental Pneumology, Pulmonary Department, City Hospital Lainz, Vienna, Austria.

出版信息

Respiration. 2000;67(4):362-6. doi: 10.1159/000029531.

DOI:10.1159/000029531

PMID:10940787

Abstract

BACKGROUND

In recent studies, the efficacy of intermittent rest of the inspiratory muscles as an option of treating patients with severe chronic obstructive pulmonary disease (COPD) has become questionable.

OBJECTIVE

The aim of our study was to analyze the effects of feedback-controlled intermittent negative pressure ventilation (INPV) on stable, but severely hypercapnic COPD patients.

METHODS

21 clinically stable, hypercapnic patients with severe COPD underwent INPV with chest shells for 3 weeks, 6 h a day. The INPV sessions were optimized by a visual biofeedback system, which enabled control over the decrease in diaphragmatic activity. Respiratory muscle (RM) function parameters, lung function parameters, blood gases and exercise capacity were analyzed.

RESULTS

In the end, 19 patients concluded INPV treatment. They had PaO(2) of 56.5 +/- 11.8 mm Hg, PaCO(2) of 50.2+/-2.7 mm Hg (mean +/- SD) and FEV(1) of 27.8 +/- 4.3% predicted before treatment. There was no statistically significant change in lung function parameters, RM function parameters, physical performance and level of dyspnea after 3 weeks of INPV.

CONCLUSION

We conclude that intermittent RM rest induced by INPV can relax inspiratory muscles in most patients with stable severe COPD, but fails to improve RM function and exercise capacity.

摘要

背景

在最近的研究中，吸气肌间歇性休息作为治疗重度慢性阻塞性肺疾病（COPD）患者的一种选择，其疗效已受到质疑。

目的

我们研究的目的是分析反馈控制的间歇性负压通气（INPV）对稳定但严重高碳酸血症的COPD患者的影响。

方法

21例临床稳定的重度COPD高碳酸血症患者使用胸甲进行INPV治疗，每天6小时，持续3周。通过视觉生物反馈系统优化INPV疗程，该系统能够控制膈肌活动的降低。分析呼吸肌（RM）功能参数、肺功能参数、血气和运动能力。

结果

最终，19例患者完成了INPV治疗。治疗前他们的动脉血氧分压（PaO₂）为56.5±11.8毫米汞柱，动脉血二氧化碳分压（PaCO₂）为50.2±2.7毫米汞柱（均值±标准差），第一秒用力呼气容积（FEV₁）为预测值的27.8±4.3%。INPV治疗3周后，肺功能参数、RM功能参数、身体表现和呼吸困难程度均无统计学显著变化。