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目的探讨无创正压通气(NIPPV)对慢性阻塞性肺疾病(COPD)急性发作期治疗后病情相对稳定患者生理反应的影响。方法9例COPD急性发作期患者接受感觉最舒适通气压力水平时的NIPPV,观察患者吸气肌肉用力和呼吸方式的变化。结果(1)患者感觉“最舒适”的IPAP为(1311±289)cmH2O,EPAP为(433±050)cmH2O。(2)与自主呼吸(SB)相比,NIPPV时的潮气量(VT)从050L升到057L(P<005),分钟通气量(VE)从1013L上升到1286L(P<001);(3)与SB相比,NIPPV时的跨膈压(Pdi)、压力时间乘积(PTP)和患者吸气做功均明显减少,分别减少74%、78%和73%(P<001)。(4)NIPPV可减轻患者呼吸困难(P<005)。结论COPD急性发作期患者无创正压通气中采用适应性逐渐增加吸气压力,寻找患者感觉舒适的最高压力的方法设定吸气压力水平,可减轻患者的呼吸肌肉负担,改善患者的呼吸方式和呼吸困难。
Objective To investigate the effect of noninvasive positive pressure ventilation (NIPPV) on the patients with relatively stable disease after acute episode of chronic obstructive pulmonary disease (COPD). Methods Nine patients with acute exacerbation of COPD received NIPPV at the level of the most comfortable sensation of ventilation, and observed changes of inspiratory muscle force and breathing patterns. Results (1) The patients who felt “the most comfortable” had IPAP of (1311 ± 289) cmH2O and EPAP of (433 ± 050) cmH2O. (2) Compared with spontaneous respiration (SB), tidal volume (VT) of NIPPV increased from 050L to 057L (P <005) and minute ventilation increased from 1013L to 1286L (P <001) Compared with SB, PIP, PTP, and inspiratory effort were significantly reduced at NIPPV by 74%, 78%, and 73% (P <001), respectively. (4) NIPPV can alleviate dyspnea in patients (P <005). Conclusion In patients with acute exacerbation of COPD, adaptability is used to gradually increase the inspiratory pressure in order to find the maximum pressure that patients feel comfortable. The method of setting inspiratory pressure can reduce the respiratory muscle burden of patients and improve the breathing patterns of patients Difficulty breathing.