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目的评价无创正压通气(NPPV)对慢性阻塞性肺疾病(COPD)急性加重期患者呼吸肌疲劳的影响。方法采用前瞻性随机对照研究,将32例 COPD 患者随机分为Ⅰ组和Ⅱ组。Ⅰ组为常规治疗+NPPV,Ⅱ组仅接受常规治疗,观察2组治疗前后辅助呼吸肌动用评分、呼吸困难评分、肺功能、动脉血气、口腔闭合压和膈神经运动传导的变化。结果治疗前2组患者均存在呼吸困难和辅助呼吸肌参与,口腔闭合压明显高于健康人,膈神经传导的潜伏期与健康人无显著差异,但动作电位的波幅明显低于健康人。治疗第8天,2组患者的症状均改善,Ⅰ组 PaCO_2降低了(31.0±17.6)mm Hg(1 mm Hg=0.133 kPa),与Ⅱ组比较,差异有统计学意义(P<0.01)。Ⅰ组患者肺功能亦显著改善,而Ⅱ组仅第1秒钟用力呼气容积有增加。Ⅰ组患者的口腔闭合压下降了(2.8±1.0)cm H_2O(1 cm H_2O=0.098 kPa),Ⅱ组仅下降了(0.3±0.5)cm H_2O。Ⅰ组患者的膈神经动作电位的波幅亦较Ⅱ组显著增高。结论 COPD 急性加重期患者治疗前均存在不同程度的呼吸肌疲劳,应用 NPPV能改善气体交换,迅速缓解呼吸肌疲劳。
Objective To evaluate the effect of noninvasive positive pressure ventilation (NPPV) on respiratory muscle fatigue in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods A prospective randomized controlled study of 32 patients with COPD were randomly divided into Ⅰ and Ⅱ groups. Group Ⅰ was treated with conventional therapy and NPPV. Group Ⅱ was treated with conventional therapy only. The scores of assist breathing muscle function, dyspnea score, pulmonary function, arterial blood gas, oral closure pressure and phrenic nerve conduction before and after treatment were observed. Results Before treatment, dyspnea and auxiliary respiratory muscles were involved in both groups. Oral closing pressure was significantly higher than that in healthy subjects. There was no significant difference in phrenic nerve conduction latency between normal subjects and healthy subjects, but the amplitude of action potential was significantly lower than that of healthy subjects. On the 8th day after treatment, the symptoms of both groups were improved. The PaCO_2 in group Ⅰ was decreased by (31.0 ± 17.6) mm Hg (1 mm Hg = 0.133 kPa). The difference was statistically significant (P <0.01). The pulmonary function in group I was also significantly improved, whereas in group II only forced expiratory volume increased in the first second. Oral closure pressure in group Ⅰ decreased by (2.8 ± 1.0) cm H_2O (1 cm H_2O = 0.098 kPa), while that in group Ⅱ decreased by (± 0.3) 0.5 cm H_2O. The amplitude of phrenic nerve action potential in group Ⅰ was also significantly higher than that in group Ⅱ. Conclusions Patients with acute exacerbation of COPD have varying degrees of respiratory muscle fatigue before treatment. NPPV can improve gas exchange and relieve respiratory muscle fatigue rapidly.