Boix Ruiz J H, Tejeda Adell M, Alvarez Cebriá F, Lara Pomares A
Unidad de Medicina Intensiva del Hospital Gran Vía, Castellón.
Rev Clin Esp. 1996 Mar;196(3):162-6.
Among the non-invasive ventilatory methods, the Nasal Intermittent Positive Pressure Ventilation (NIPPV) can cause important effects on circulation since a positive intrathoracic pressure is obtained and thus in the transmural cardiac pressure. In contrast, the External High Frequency Oscillation around a Negative Baseline (EHFO-NB) obtains a negative thoracic pressure. Therefore, the opposite circulatory changes should be expected.
To study and compare the effects on the left systolic and diastolic ventricular functions derived from the application of both NIPPV and EHFO-NB ventilatory support methods in patients with chronic obstructive pulmonary disease (COPD).
Nine patients with COPD were studied. The investigation was carried out from the third to the seventh day of follow-up at the ICU. For each patient three equilibrium radionuclide angiocardiography (ERA) were performed. With the patient breathing room air spontaneously, 45 minutes after ventilatory support with NIPPV and also 45 minutes after ventilatory support with EHFO-NB. Measurements of radionuclide activity (counts) and derived parameter of left systolic and ventricular functions were determined following a previously reported protocol.
During ventilatory support with NIPPV a significant increase in the time elapsed since the end of the diastole to the peak systolic ejection was observed. During ventilatory support with EHFO-NB a significant decrease in cardiac radioactivity (counts) in tele-systole was observed together with an increase in the ejection velocity measured in the first third of the systolic phase. These findings occurred both with respect to the basal situation and to the ventilatory phase with NIPPV:
Under the study conditions, none of the non-invasive ventilatory support methods compromised hemodynamic parameters in patients studied. Ventilation with EHFO-NB improved the left ventricular function.
在无创通气方法中，鼻间歇正压通气（NIPPV）可对循环产生重要影响，因为会获得正的胸内压，进而影响跨壁心压。相比之下，围绕负基线的体外高频振荡（EHFO-NB）可获得负的胸内压。因此，预期会出现相反的循环变化。
研究并比较无创正压通气（NIPPV）和围绕负基线的体外高频振荡（EHFO-NB）这两种通气支持方法对慢性阻塞性肺疾病（COPD）患者左心室收缩和舒张功能的影响。
对9例COPD患者进行了研究。在重症监护病房（ICU）随访的第3天至第7天进行调查。对每位患者进行了三次平衡放射性核素血管造影（ERA）。患者自主呼吸空气时、NIPPV通气支持45分钟后以及EHFO-NB通气支持45分钟后各进行一次。按照先前报告的方案测定放射性核素活性（计数）以及左心室收缩和舒张功能的派生参数。
在NIPPV通气支持期间，观察到舒张末期至收缩期射血峰值的时间显著增加。在EHFO-NB通气支持期间，观察到远心收缩期心脏放射性（计数）显著降低，同时收缩期前三分之一测量的射血速度增加。这些发现相对于基础情况以及NIPPV通气阶段均出现：
在研究条件下，所研究的无创通气支持方法均未损害患者的血流动力学参数。EHFO-NB通气改善了左心室功能。
