[正压通气联合膈肌起搏对呼吸衰竭患者呼吸力学的影响]

[The effect of positive pressure ventilation combined with diaphragm pacing on respiratory mechanics in patients with respiratory failure].

作者信息

Deng Yi-Jun, Ji You-Lin, Chen Lan-Ping, Jin Qin

机构信息

Intensive Care Unit, the First People's Hospital of Yancheng, Yancheng 224001, Jiangsu, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Apr;23(4):213-5.

PMID:21473822

Abstract

OBJECTIVE

To observe the effects of combining positive pressure ventilation with diaphragm pacing on respiratory mechanics in patients with respiratory failure.

METHODS

Twenty patients with central respiratory failure were studied with cohorts. The effects on respiratory mechanics were respectively observed in patients in control group, in whom ventilation by positive pressure only, and patients in experimental group in whom ventilation was instituted by combining positive pressure ventilation with diaphragm pacing.

RESULTS

Compared with control group, mean airway pressure (Paw, cm H(2)O, 1 cm H(2)O= 0.098 kPa) and plateau pressure (Pplat, cm H(2)O) were significantly decreased in experimental group (Paw: 6.1±1.3 vs. 7.3±1.8; Pplat: 10.4±2.5 vs. 12.1±2.6, both P<0.05), while the negative value of peak esophageal pressure (P(PEAK ES) , cm H(2)O), the negative value of the difference between peak and basic esophageal pressure (dP(ES), cm H(2)O), transpulmonary pressure at end of inspiration hold (Ptp plat, cm H(2)O ), static compliance (Cst, ml/cm H(2)O) were significantly increased in experimental group (P(PEAK ES): -8.3± 1.9 vs. -3.2±1.4; dP(ES) : -11.2±2.6 vs. -8.2±2.2; Ptp plat: 23.6±3.8 vs. 15.6±3.1; Cst: 52.7±8.2 vs. 48.3±7.2, all P<0.05). No differences were found in airway resistance (Raw, cm H(2)O×L(-1) ×s(-1) ) and lung resistance (R(L), cm H(2)O×L(-1) ×s(-1) ) between experimental group and control group (Raw: 2.1±0.5 vs. 2.3±0.4; R(L): 2.9±0.6 vs. 3.1±0.5, both P>0.05). Work of breath by patient (WOBp, J/L) was significantly increased and work of breath by ventilator (WOBv, J/L) was significantly decreased in experimental group compared with control group (WOBp: 0.18±0.03 vs. 0; WOBv: 0.31±0.07 vs. 0.53±0.11, both P<0.05).

CONCLUSION

Compared with positive pressure ventilation , positive pressure ventilation combined with diaphragm pacing can decrease the Paw, increase intrathoracic negative pressure, transpulmonary pressure, and Cst, and decrease WOBv, while there is no effect on Raw and R(L).

摘要

目的

观察正压通气联合膈肌起搏对呼吸衰竭患者呼吸力学的影响。

方法

对20例中枢性呼吸衰竭患者进行队列研究。分别观察仅采用正压通气的对照组患者以及采用正压通气联合膈肌起搏通气的实验组患者对呼吸力学的影响。

结果

与对照组相比，实验组的平均气道压（Paw，cm H₂O，1 cm H₂O = 0.098 kPa）和平台压（Pplat，cm H₂O）显著降低（Paw：6.1±1.3 vs. 7.3±1.8；Pplat：10.4±2.5 vs. 12.1±2.6，均P<0.05），而实验组的食管峰值压负值（P(PEAK ES)，cm H₂O）、食管峰值与基础值压差负值（dP(ES)，cm H₂O）、吸气末屏气时的跨肺压（Ptp plat，cm H₂O）、静态顺应性（Cst，ml/cm H₂O）显著升高（P(PEAK ES)：-8.3±1.9 vs. -3.2±1.4；dP(ES)：-11.2±2.6 vs. -8.2±2.2；Ptp plat：23.6±3.8 vs. 15.6±3.1；Cst：52.7±8.2 vs. 48.3±7.2，均P<0.05）。实验组与对照组之间的气道阻力（Raw，cm H₂O×L⁻¹×s⁻¹）和肺阻力（R(L)，cm H₂O×L⁻¹×s⁻¹）无差异（Raw：2.1±0.5 vs. 2.3±0.4；R(L)：2.9±0.6 vs. 3.1±0.5，均P>0.05）。与对照组相比，实验组患者的自主呼吸功（WOBp，J/L）显著增加，呼吸机做功（WOBv，J/L）显著降低（WOBp：0.18±0.03 vs. 0；WOBv：0.31±0.07 vs. 0.53±0.11，均P<0.05）。