持续气道正压通气可增加慢性阻塞性肺疾病患者的吸气能力。

Continuous positive airway pressure increases inspiratory capacity of COPD patients.

作者信息

Soares Silvia M T P, Oliveira Rosmari A R A, Franca Suelene A, Rezende Silvio M, Dragosavac Desanka, Kacmarek Robert M, Carvalho Carlos R R

机构信息

Intensive Care Unit, State University of Campinas, Brazil.

出版信息

Respirology. 2008 May;13(3):387-93. doi: 10.1111/j.1440-1843.2008.01263.x.

DOI:10.1111/j.1440-1843.2008.01263.x

PMID:18399861

Abstract

BACKGROUND AND OBJECTIVE

Hyperinflation with a decrease in inspiratory capacity (IC) is a common presentation for both unstable and stable COPD patients. As CPAP can reduce inspiratory load, possibly secondary to a reduction in hyperinflation, this study examined whether CPAP would increase IC in stable COPD patients.

METHODS

Twenty-one stable COPD patients (nine emphysema, 12 chronic bronchitis) received a trial of CPAP for 5 min at 4, 7 and 11 cmH(2)O. Fast and slow VC (SVC) were measured before and after each CPAP trial. In patients in whom all three CPAP levels resulted in a decreased IC, an additional trial of CPAP at 2 cmH(2)O was conducted. For each patient, a 'best CPAP' level was defined as the one associated with the greatest IC. This pressure was then applied for an additional 10 min followed by spirometry.

RESULTS

Following application of the 'best CPAP', the IC and SVC increased in 15 patients (nine emphysema, six chronic bronchitis). The mean change in IC was 159 mL (95% CI: 80-237 mL) and the mean change in SVC was 240 mL (95% CI: 97-386 mL). Among these patients, those with emphysema demonstrated a mean increase in IC of 216 mL (95% CI: 94-337 mL). Six patients (all with chronic bronchitis) did not demonstrate any improvement in IC.

CONCLUSIONS

The best individualized CPAP can increase inspiratory capacity in patients with stable COPD, especially in those with emphysema.

摘要

背景与目的

吸气容量（IC）降低的肺过度充气在不稳定和稳定的慢性阻塞性肺疾病（COPD）患者中均很常见。由于持续气道正压通气（CPAP）可降低吸气负荷，可能继发于肺过度充气的减轻，本研究探讨CPAP是否会增加稳定期COPD患者的IC。

方法

21例稳定期COPD患者（9例肺气肿，12例慢性支气管炎）分别在4、7和11 cmH₂O水平接受5分钟的CPAP试验。每次CPAP试验前后测量快速肺活量（FVC）和慢肺活量（SVC）。对于所有三个CPAP水平均导致IC降低的患者，进行2 cmH₂O水平的CPAP额外试验。对于每位患者，“最佳CPAP”水平定义为与最大IC相关的水平。然后将该压力再施加10分钟，随后进行肺量计检查。

结果

应用“最佳CPAP”后，15例患者（9例肺气肿，6例慢性支气管炎）的IC和SVC增加。IC的平均变化为159 mL（95%CI：80 - 237 mL），SVC的平均变化为240 mL（95%CI：97 - 386 mL）。在这些患者中，肺气肿患者的IC平均增加216 mL（95%CI：94 - 337 mL）。6例患者（均为慢性支气管炎）的IC未显示任何改善。