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目的 确定在慢性阻塞性肺疾病 (COPD)患者中应用外源性呼气末正压 (PEEPe)的适宜水平 ,并比较两种选择PEEPe的方法。方法 选取气管插管机械通气的COPD患者 10例 ,首先测定PEEPe为 0时的静态内源性呼气末正压 (表示为PEEPi,stz) ,再以PEEPi,stz的 0 %、4 0 %、5 0 %、60 %、70 %、80 %、90 %和 10 0 %随机设置PEEPe水平 ,在不同PEEPe水平下分别测定呼吸力学、血流动力学和氧动力学指标。结果 当PEEPe水平不高于PEEPi,stz的 80 %时 ,各项指标均变化不明显 ;当PEEPe加至PEEPi,stz的 90 %和10 0 %时 ,静态内源性呼气末正压、吸气峰压、平台压、肺毛细血管嵌顿压和中心静脉压均显著升高 ,P均 <0 0 1;心排血量、左室做功指数均显著下降 ,P均 <0 0 1;氧输送量也明显下降 ,P均 <0 0 5 ;当PEEPe加至PEEPi,stz的10 0 %时 ,右室做功指数明显下降 ,P <0 0 5。结论 PEEPi,stz的 80 %为可加用PEEPe的上限 ,两种选择PEEPe的方法结果相同。
Objective To determine the appropriate level of exogenous PEEP in patients with chronic obstructive pulmonary disease (COPD) and to compare two methods of selecting PEEPe. Methods Totally 10 COPD patients with mechanical ventilation of endotracheal intubation were enrolled. First of all, static endogenous positive end expiratory pressure (PEEPi, stz) was measured when PEEPe was 0, then PEEPi, stz 0%, 40% PEEPe levels were set randomly at 50%, 60%, 70%, 80%, 90% and 100% respectively. Respiratory mechanics, hemodynamics and oxygen kinetic parameters were measured at different levels of PEEPe. Results When the level of PEEPe was not higher than 80% of PEEPi, stz, the indexes did not change obviously. When PEEPe was added to 90% and 100% of PEEPi, stz, static endogenous positive expiratory pressure, Peak pressure, plateau pressure, pulmonary capillary incarceration pressure and central venous pressure were significantly increased, P <0 01; cardiac output, left ventricular work index decreased significantly, P <0.01; oxygen The volume of delivery also decreased significantly (P <0.05). When PEEPe was added to 100% of PEEPi and stz, the work index of right ventricle decreased obviously (P <0.05). Conclusion 80% of PEEPi and stz are the upper limits of PEEPe, and the results of two methods of PEEPe are the same.