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目的:观察沙丁胺醇联合外源性呼气末正压通气(PEEPe)对慢性阻塞性肺疾病(COPD)患者生理功能的影响。方法:将对支气管扩张剂有反应性,伴有中度内源性呼气末正压通气(PEEPi)的机械性通气COPD患者10例,分别在插管后30min(ZEEPe-Ⅰ),雾化吸入5mg沙丁胺醇后30min(ZEEPe-S),首次雾化吸入沙丁胺醇后8h到PEEPe通气前的15min(ZEEPe-Ⅱ),在基础水平PEEPi上设置PEEPe后30min(PEEPe-30),雾化吸入5mg沙丁胺醇和PEEPe结合治疗后30min(PEEPe-S)时,评测患者的呼吸系统力学、血液动力学和气体交换功能。在PEEPe通气前检测确定变量的基础值。结果:与ZEEPe-I时间点比较,ZEEPe-S时间点最大总呼气阻力、最小呼吸阻力、附加肺呼吸阻力、功能残气量的变化、PEEPi、肺毛细血管楔压和全身血管阻力均显著降低(P<0.01),心率、混合静脉血氧饱和度和氧输送量显著提高(P<0.01);在PEEPe-30治疗时间点PEEPi、二氧化碳分压和静脉血掺杂比显著降低(P<0.01);在PEEPe-S时间点最大总呼气阻力、最小呼吸阻力、功能残气量的变化、肺毛细血管楔压、静脉血掺杂比和全身血管阻力显著降低(P<0.01),心率、氧输送量和动脉血氧分压显著提高(P<0.01)。结论:对于有中度PEEPi-COPD患者,沙丁胺醇联合PEEPe有累加的治疗作用。
Objective: To observe the effects of albuterol combined with exogenous end-expiratory pressure (PEEPe) on the physiological function of patients with chronic obstructive pulmonary disease (COPD). Methods: Ten patients with COPD undergoing moderate endogenous positive end expiratory pressure (PEEPi) with reactivity to bronchodilators were anesthetized with ZEEPe-I, 30 min after inhalation of 5 mg salbutamol (ZEEPe-S), 8 h after nebulization of the first inhalation of albuterol to 15 min before PEEPe ventilation (PEEPe-30) 30 min after basal PEEPi (PEEPe-30), inhalation of 5 mg salbutamol Patients were assessed for respiratory mechanics, hemodynamics, and gas exchange at 30 min after PEEPe (PEEPe-S). Prior to PEEPe ventilation, the baseline values of the variables were determined. Results: Compared with ZEEPe-I time point, the maximum total expiratory resistance, minimum respiratory resistance, additional lung resistance, functional residual capacity, PEEPi, pulmonary capillary wedge pressure and systemic vascular resistance were significantly decreased (P <0.01), heart rate, mixed venous oxygen saturation and oxygen delivery increased significantly (P <0.01). PEEPi, carbon dioxide partial pressure and venous blood doping ratio decreased significantly at PEEPe-30 treatment time ); The maximum total expiratory resistance, minimum respiratory resistance, functional residual volume changes at PEEPe-S time point, pulmonary capillary wedge pressure, venous blood doping ratio and systemic vascular resistance were significantly decreased (P <0.01) Delivery volume and arterial oxygen pressure increased significantly (P <0.01). Conclusions: Salbutamol combined with PEEPe has an additive therapeutic effect in patients with moderate PEEPi-COPD.