[高碳酸血症型慢性阻塞性肺疾病患者无创压力支持下自主呼吸时的人机交互]

[Patient-ventilator interaction during noninvasive pressure supported spontaneous respiration in patients with hypercapnic COPD].

作者信息

Pankow W, Becker H, Köhler U, Schneider H, Penzel T, Peter J H

机构信息

Zentrum für Innere Medizin, Abteilung Medizinische Poliklinik, Zeitreihenlabor, Philipps-Universität, Marburg.

出版信息

Pneumologie. 2001 Jan;55(1):7-12. doi: 10.1055/s-2001-10445.

DOI:10.1055/s-2001-10445

PMID:11236359

Abstract

BACKGROUND

Noninvasive pressure support ventilation (NPSV) demands triggering with each breath. This study investigates the effects of NPSV via face mask on breathing pattern, ventilation and respiratory muscle loading in patients with hypercapnic stable COPD.

METHODS

7 patients (age 66 +/- 9 years; FEV1 43 +/- 13% predicted; PaO2 52 +/- 19 mmHg; PaCO2 58 +/- 12 mmHg) were included. The physiologic variables were evaluated during spontaneous breathing and at the end of a 60 minutes period with NPSV. Inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) were adjusted to 12-14 cm H2O and 3 cm H2O, respectively. Respiratory muscle activity was measured as esophageal and transdiaphragmatic pressure time product (PTPes and PTPdi).

RESULTS

Non-triggering was observed only occasionally. Compared to unsupported spontaneous breathing NPSV improved ventilation: PaCO2 was reduced from 58 +/- 11 mmHg to 50 +/- 14 mmHg (p +/- 0.05). Respiratory muscles were unloaded by 30% (p +/- 0.05). Breathing frequency and breathing pattern did not change.

CONCLUSIONS

In patients with hypercapnic stable COPD NPSV effectively recognizes and supports breathing efforts. As a result ventilation is improved and respiratory muscles are unloaded.

摘要

背景

无创压力支持通气（NPSV）每次呼吸都需要触发。本研究调查了通过面罩进行NPSV对高碳酸血症稳定期慢性阻塞性肺疾病（COPD）患者呼吸模式、通气和呼吸肌负荷的影响。

方法

纳入7例患者（年龄66±9岁；预测FEV1为43±13%；PaO2为52±19 mmHg；PaCO2为58±12 mmHg）。在自主呼吸期间以及NPSV 60分钟结束时评估生理变量。吸气气道正压（IPAP）和呼气气道正压（EPAP）分别调整为12 - 14 cm H2O和3 cm H2O。将呼吸肌活动测量为食管和跨膈压时间乘积（PTPes和PTPdi）。