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目的为提高慢性阻塞性肺疾病(COPD)患者撤机成功率提供生理学依据。方法检测2006年1月至2009年12月广州医学院第一附属医院收治的10例撤机困难COPD患者的呼吸力学指标,观察患者自主呼吸(SB)及机械通气时的呼吸力学指标变化。结果 SB时的呼吸频率(RR)、潮气量(VT)和分钟通气量(Ve)分别为(27.94±8.23)次/min、(0.266±0.107)L和(6.843±1.333)L/min,机械通气时的RR降低,而VT和Ve时升高(均P<0.05)。SB和机械通气时的动态内源性呼吸末正压分别为(0.82±0.19)kPa和(0.41±1.12)kPa,SB时明显增高(P<0.01),吸气中期气道阻力(RL)(2.43±0.94)kPa/(L.S)。SB时的P0.1为(0.61±0.16)kPa。SB时的最大跨膈压、最大食管负压和最大吸气口腔压分别为(5.08±0.93)kPa、(-5.00±0.95)kPa和(-3.78±0.86)kPa。SB时跨膈压(Pdi)和吸气压力时间乘积(PTPins)分别为(0.82±0.20)kPa和(48.93±11.94)kPa.s;机械通气时较SB显著降低,分别为(0.67±0.17)kPa和(30.33±11.72)kPa.s(P均<0.05)。结论撤机困难COPD患者存在显著的呼吸力学异常,SB时呼吸浅快,动态内源性呼吸末正压、RL与呼吸中枢驱动等均增高,吸气肌肉无力;应用PSV(1.57 kPa)联合PEEP(48%动态内源性呼吸末正压)可降低约50%的动态内源性呼吸末正压、17.8%的Pdi和38%的PTPins。
Objective To provide a physiological basis for improving the weaning success rate in patients with chronic obstructive pulmonary disease (COPD). Methods The respiratory mechanics indexes of 10 patients with weaning dysfunction admitted to the First Affiliated Hospital of Guangzhou Medical College from January 2006 to December 2009 were measured to observe the change of respiratory mechanics index during spontaneous breathing (SB) and mechanical ventilation. Results The respiratory rate (RR), tidal volume (VT) and minute ventilation (Ve) were (27.94 ± 8.23) / min, (0.2666 ± 0.107) L and (6.843 ± 1.333) L / Ventilation RR decreased, while VT and Ve increased (P <0.05). The dynamic endogenous positive end-expiratory pressure during SB and mechanical ventilation were (0.82 ± 0.19) kPa and (0.41 ± 1.12) kPa respectively, significantly higher at SB (P <0.01), middle airway resistance (RL) 2.43 ± 0.94) kPa / (LS). P0.1 at SB was (0.61 ± 0.16) kPa. The maximum diastolic pressure, maximum esophageal pressure and maximum inspiratory pressure at SB were (5.08 ± 0.93) kPa, (-5.00 ± 0.95) kPa and (-3.78 ± 0.86) kPa, respectively. The PTP and SBP were (0.82 ± 0.20) kPa and (48.93 ± 11.94) kPa.s respectively at SB and 0.67 ± 0.17 respectively when compared with SB at mechanical ventilation kPa and (30.33 ± 11.72) kPa.s (P <0.05). Conclusions There are significant respiratory mechanics abnormalities in COPD patients with weaning failure, SB with fast breathing, positive endogenous positive end-expiratory pressure, RL and respiratory center drive, and inspiratory muscle weakness. PSV (1.57 kPa) combined with PEEP (48% dynamic endogenous positive end-expiratory pressure) reduced dynamic endogenous positive end-expiratory pressure of about 50%, Pdi of 17.8%, and PTPins of 38%.