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胸外机械通气对肺部疾病继发肺动脉高压的影响。

Effects of extrathoracic mechanical ventilation on pulmonary hypertension secondary to lung disease.

作者信息

Sato Yoko, Saeki Noriyuki, Asakura Takuma, Aoshiba Kazutetsu, Kotani Toru

机构信息

Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Synthesis Shinkawabashi Hospital, 1-15 Shinkawadori, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0013, Japan.

出版信息

J Anesth. 2016 Aug;30(4):663-70. doi: 10.1007/s00540-016-2172-7. Epub 2016 Apr 18.

DOI:10.1007/s00540-016-2172-7
PMID:27090795
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4956720/
Abstract

PURPOSE

Biphasic cuirass ventilation (BCV) is a form of non-invasive extrathoracic positive and negative pressure mechanical ventilation. The present study was conducted to quantify our positive experience using BCV to dramatically improve gas exchange and cardiac function in patients with acute exacerbation of chronic respiratory failure and secondary pulmonary hypertension (PH).

METHODS

BCV was applied for 2 weeks in 17 patients with PH caused by lung disease. Ventilation sessions were limited to 1 h per day to prevent exhaustion. To assess respiratory and circulatory effects, percutaneous arterial oxygen saturation (SpO2) was measured before and after each daily BCV session, and right heart catheter test [mean pulmonary artery pressure (mPAP), right atrium pressure (RAP), pulmonary artery occlusion pressure (PAOP) and cardiac index (CI)] and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before and after a series of BCV sessions.

RESULTS

SpO2 transiently improved after each BCV session. After a series of BCV, mPAP decreased from 27.2 to 22.4 mmHg (p = 0.0007). PAOP, CI and serum NT-proBNP levels decreased compared with baseline. No patients were treated with epoprostenol, iloprost, bosentan or sildenafil for PH.

CONCLUSION

BCV may improve circulatory function in patients with PH caused by lung disease.

摘要

目的

双相胸甲通气（BCV）是一种无创性胸外正负压机械通气形式。本研究旨在量化我们使用BCV显著改善慢性呼吸衰竭急性加重和继发性肺动脉高压（PH）患者气体交换和心脏功能的积极经验。

方法

对17例肺部疾病所致PH患者应用BCV治疗2周。通气时间限制在每天1小时以防止疲劳。为评估呼吸和循环效应，在每日BCV治疗前后测量经皮动脉血氧饱和度（SpO2），并在一系列BCV治疗前后测量右心导管检查指标[平均肺动脉压（mPAP）、右心房压（RAP）、肺动脉闭塞压（PAOP）和心脏指数（CI）]以及血清N末端脑钠肽前体（NT-proBNP）。

结果

每次BCV治疗后SpO2短暂改善。经过一系列BCV治疗后，mPAP从27.2 mmHg降至22.4 mmHg（p = 0.0007）。与基线相比，PAOP、CI和血清NT-proBNP水平下降。没有患者因PH接受依前列醇、伊洛前列素、波生坦或西地那非治疗。

结论

BCV可能改善肺部疾病所致PH患者的循环功能。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/c76076ee72e0/540_2016_2172_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/9767687e71fa/540_2016_2172_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/00255fecb4e5/540_2016_2172_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/c76076ee72e0/540_2016_2172_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/9767687e71fa/540_2016_2172_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/00255fecb4e5/540_2016_2172_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/020b/4956720/c76076ee72e0/540_2016_2172_Fig3_HTML.jpg

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