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COPD急性恶化期需应用机械通气处理。因COPD患者存在着较高水平的PEEPi,故对通气设置及效果有较大影响。如忽视REEPi,可导致治疗失败,应引起RICU医生的高度重视。 1 呼气末正压对COPD患者的影响 1.1 对血流动力学影响:PEEP(i)(内生性或外加PEEP)可导致胸腔正压,使回心血量减少而降低了心脏前负荷,按Frank-starling定律,心输出量(CO)减少。另外PEEP(i)使肺血管床被“压缩”而减少,使右心后负荷增加。PEEP(i)可使冠状动脉及心内膜供血下降而使右心功能下降,引起CO减少,甚至严重的心律失常。 1.2 对胸腔内压力影响:因过高PEEP(i)使肺
COPD acute exacerbation required the application of mechanical ventilation. Due to the presence of a high level of PEEPi in patients with COPD, ventilation settings and effects have a greater impact. Such as neglect of REEPi, can lead to treatment failure, should be caused by the RICU doctor’s attention. 1 end-expiratory pressure in patients with COPD 1.1 The hemodynamic effects: PEEP (i) (endogenous or PEEP) can lead to positive pressure in the chest, so that less blood back to the heart and reduce preload, according to Frank Starling’s law, cardiac output (CO) decreased. In addition, PEEP (i) reduces the pulmonary vascular bed by “compression” and increases the post-right heart load. PEEP (i) can make coronary and endocardial blood supply decreased right heart function decreased, causing decreased CO, or even serious arrhythmia. 1.2 on the impact of intrathoracic pressure: due to excessive PEEP (i) to make the lungs