Huang Tao, Zhou Fa-Chun, Wan Dong, Liu Qiong
Department of Central Intensive Care Unit, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Apr;23(4):216-9.
To observe difference in clinical effect between single hole exhalation valve and plateau exhalation valve when used in patients treated with BiPAP Vision ventilator for chronic obstructive pulmonary disease (COPD) with hypercapnia.
Forty seven patients with hypercapnia due to COPD, who were admitted to the central intensive care unit (ICU) in the First Affiliated Hospital of Chongqing Medical University from October 2008 to July 2010, treated with noninvasive positive pressure ventilation (NIPPV) by BiPAP Vision ventilator, were enrolled in the study. The patients were divided randomly into NIPPV with application of single hole exhalation valve group (n=22) and plateau exhalation valve group (n=25). In each group, parameters of the arterial blood gas, including arterial partial pressure of oxygen (PaO(2)) and arterial partial pressure of carbon dioxide (PaCO2), were measured at the time points of 0, 2, 4, 8, 24, 48 hours of NIPPV and 24 hours post NIPPV.
The general conditions were similar in both groups at 0 hour. Compared with that of 0 hour, marked improvement in PaO(2) (mm Hg, 1 mm Hg=0.133 kPa, single hole exhalation valve group: 70.4±10.2, 78.7± 10.4, 82.6±9.2, 86.5±9.6, 90.4±9.0, 91.3±8.9 vs. 57.2±16.4; plateau exhalation valve group: 71.1±12.3, 77.9±11.6, 83.3±8.9, 85.9±8.2, 89.4±8.2, 92.1±8.5 vs. 56.9±17.2) and obvious lowering of PaCO(2) (mm Hg, single hole exhalation valve group: 76.3±11.9, 74.1±12.7, 71.3±11.2, 67.4±10.5, 65.4±8.2, 61.4±7.9 vs. 85.7±19.2; plateau exhalation valve group: 72.6±10.5, 70.1±11.5, 67.4±10.1, 63.9±9.7, 62.8±7.7, 59.1±7.3 vs. 86.3±17.9) were observed at the time points of 2, 4, 8, 24, 48 hours of NIPPV and 24 hours post NIPPV in both groups (all P<0.05). Comparing single hole exhalation valve group with plateau exhalation valve group, PaO2 showed no statistical significance at the same time point (all P>0.05). However, PaCO(2) was significantly lower in plateau exhalation valve group than that in single hole exhalation valve group at the time points of 2, 4, 8 and 24 hours (all P<0.05).
During BiPAP Vision ventilator in NIPPV treatment of patients with COPD complicated with CO2 retention , single hole exhalation valve and plateau exhalation valve both resulted in marked improvement in PaO2 and obvious decrease in PaCO2. Plateau exhalation valve corrected CO2 retention more quickly and effectively than side hole exhalation valve probably by preventing CO2 rebreathing by the patients.
观察单孔呼气阀与平台呼气阀在使用BiPAP Vision呼吸机治疗慢性阻塞性肺疾病（COPD）合并高碳酸血症患者时的临床效果差异。
选取2008年10月至2010年7月在重庆医科大学附属第一医院中心重症监护病房（ICU）住院的47例因COPD导致高碳酸血症、采用BiPAP Vision呼吸机进行无创正压通气（NIPPV）治疗的患者纳入研究。将患者随机分为应用单孔呼气阀的NIPPV组（n = 22）和平台呼气阀组（n = 25）。每组在NIPPV治疗0、2、4、8、24、48小时及NIPPV治疗后24小时时间点测定动脉血气参数，包括动脉血氧分压（PaO₂）和动脉血二氧化碳分压（PaCO₂）。
两组患者0小时时一般情况相似。与0小时时相比，两组在NIPPV治疗2、4、8、24、48小时及NIPPV治疗后24小时时间点时PaO₂均显著改善（mmHg，1 mmHg = 0.133 kPa，单孔呼气阀组：70.4±10.2，78.7±10.4，82.6±9.2，86.5±9.6，90.4±9.0，91.3±8.9 vs. 57.2±16.4；平台呼气阀组：71.1±12.3，77.9±11.6，83.3±8.9，85.9±8.2，89.4±8.2，92.1±8.5 vs. 56.9±17.2），PaCO₂均明显降低（mmHg，单孔呼气阀组：76.3±11.9，74.1±12.7，71.3±11.2，67.4±10.5，65.4±8.2，61.4±7.9 vs. 85.7±19.2；平台呼气阀组：72.6±10.5，70.1±11.5，67.4±10.1，63.9±9.7，62.8±7.7，59.1±7.3 vs. 86.3±17.9）（均P < 0.05）。单孔呼气阀组与平台呼气阀组相比，同一时间点PaO₂差异无统计学意义（均P > 0.05）。但在2、4、8及24小时时间点时，平台呼气阀组PaCO₂显著低于单孔呼气阀组（均P < 0.05）。
在使用BiPAP Vision呼吸机进行NIPPV治疗COPD合并CO₂潴留患者过程中，单孔呼气阀和平台呼气阀均可使PaO₂显著改善、PaCO₂明显降低。平台呼气阀可能通过防止患者重复吸入CO₂，比侧孔呼气阀更快速有效地纠正CO₂潴留。
