慢性阻塞性肺疾病(COPD)患者从稳定状态到伴有呼吸衰竭的急性加重期呼吸力学的变化

Changes of Respiratory Mechanics in COPD Patients from Stable State to Acute Exacerbations with Respiratory Failure.

作者信息

Ceriana Piero, Vitacca Michele, Carlucci Annalisa, Paneroni Mara, Pisani Lara, Nava Stefano

机构信息

a Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Pavia , Pavia , Italy.

b Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Institute of Lumezzane , Lumezzane , Italy.

出版信息

COPD. 2017 Apr;14(2):150-155. doi: 10.1080/15412555.2016.1254173. Epub 2016 Dec 20.

Abstract

Symptoms, clinical course, functional and biological data during an exacerbation of chronic obstructive pulmonary disease (EXCOPD) have been investigated, but data on physiological changes of respiratory mechanics during a severe exacerbation with respiratory acidosis requiring noninvasive mechanical ventilation (NIMV) are scant. The aim of this study was to evaluate changes of respiratory mechanics in COPD patients comparing data observed during EXCOPD with those observed during stable state in the recovery phase. In 18 COPD patients having severe EXCOPD requiring NIMV for global respiratory failure, we measured respiratory mechanics during both EXCOPD (T0) and once the patients achieved a stable state (T1). The diaphragm and inspiratory muscles effort was significantly increased under relapse, as well as the pressure-time product of the diaphragm and the inspiratory muscle (PTPdi and PTPes). The resistive loads to breathe (i.e., PEEPi,dyn, compliance and inspiratory resistances) were also markedly increased, while the maximal pressures generated by the diaphragm and the inspiratory muscles, together with forced expired volumes were decreased. All these indices statistically improved but with a great intrasubject variability in stable condition. Moreover, tension-time index (TTdi) significantly improved from the EXCOPD state to the condition of clinical stability (0.156 ± 0.04 at T0 vs. 0.082 ± 0.02 at T1 p < 0.001). During an EXCOPD, the load/capacity of the respiratory pump is impaired, and although the patients exhibit a rapid shallow breathing pattern, this does not necessarily correlate with a TTdi ≥ 0.15. These changes are reverted once they recover from the EXCOPD, despite a large variability between patients.

摘要

慢性阻塞性肺疾病急性加重期(EXCOPD)的症状、临床病程、功能和生物学数据已得到研究,但关于严重急性加重期合并呼吸性酸中毒且需要无创机械通气(NIMV)时呼吸力学生理变化的数据却很少。本研究的目的是评估慢性阻塞性肺疾病(COPD)患者呼吸力学的变化,比较EXCOPD期间观察到的数据与恢复阶段稳定状态下观察到的数据。在18例因严重EXCOPD导致全球呼吸衰竭而需要NIMV的COPD患者中,我们在EXCOPD期间(T0)以及患者达到稳定状态时(T1)测量了呼吸力学。复发时膈肌和吸气肌的努力显著增加,膈肌和吸气肌的压力-时间乘积(PTPdi和PTPes)也显著增加。呼吸的阻力负荷(即内源性呼气末正压、动态顺应性和吸气阻力)也明显增加,而膈肌和吸气肌产生的最大压力以及用力呼气量则降低。所有这些指标在统计学上均有所改善,但在稳定状态下个体内差异很大。此外,张力-时间指数(TTdi)从EXCOPD状态到临床稳定状态有显著改善(T0时为0.156±0.04,T1时为0.082±0.02,p<0.001)。在EXCOPD期间,呼吸泵的负荷/能力受损,尽管患者表现出快速浅呼吸模式,但这不一定与TTdi≥0.15相关。尽管患者之间存在很大差异,但一旦从EXCOPD中恢复,这些变化就会逆转。

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