【作者】 姜辉；

【导师】 俞森洋；

【作者基本信息】 中国人民解放军军医进修学院 ， 呼吸内科， 2005， 博士

【摘要】 目的 (1) 通过分析潮气呼吸流速-容积曲线、二氧化碳时间曲线以及二氧化碳容量曲线参数,了解间歇正压通气(IPPV)、双相气道正压通气(BIPAP)和自动变流(autoflow)模式对慢性阻塞性肺病(COPD)患者呼吸力学的影响。(2) 通过改变压力上升速度,了解对压力支持通气(PSV)呼吸力学参数和吸呼切换的影响。(3) 通过比较PSV模式联合自动插管补偿(ATC)前后的呼吸力学参数,了解PSV+ATC是否优于PSV模式。(4) 通过比较Smartcare脱机模式和间断停用呼吸机两种脱机方法,了解Smartcare脱机模式是否可以提高COPD患者的脱机成功率。 方法 (1) 对21例处于稳定期的老年COPD患者进行IPPV、BIPAP和autodlow通气治疗,比较不同通气模式对呼吸力学参数的影响。(2) 对19例COPD患者使用PSV模式进行通气治疗,比较改变压力上升速度以及使用ATC前后对呼吸力学参数的影响。(3) 38例COPD患者随机分为Smartcare脱机组和间断停用呼吸机组,进行脱机治疗。 结果 (1) COPD患者的内源性呼气末正压与呼气峰夹角和呼气末流速明显相关。(2) BIPAP和autoflow模式可以降低气道压,增加肺动态顺应性,使死腔增大。(3) 压力上升速度越快,COPD患者在PSV模式时吸气肌用力越小。(4) 压力上升速度大小与PSV模式的吸呼切换同步与否无关。(5) PSV+ATC会增加无效触发呼吸次数,同时使高潮气量报警次数增多。(6) Smartcare脱机模式的7天脱机成功率高于间断停用呼吸机的脱机方法。 结论 (1) BIPAP和autoflow模式时宜提高吸气流速,增加气体弥散,减少死腔。(2) 对于老年COPD患者,使用Ramp0.2的压力上升速度较好。(3)PSV+ATC模式不适用于COPD患者。(4) Smartcare脱机模式在7天内的脱机成功率优于间断停用呼吸机的脱机方法。更多还原

【Abstract】 Objectives (1).To compare the respiratory mechanics of intermittent positive pressure ventilation(IPPV),biphasic-positive airway pressure(BIPAP) and autoflow by analysis parameters of Flow-volume curves , time capnogram and volumetric capnography. (2). To evaluate the effects of pressure ramp slop values on respiratory mechanics and inspiration termination criteria during pressure support ventilation(PSV).(3).To assess the respiratory mechanic of PSV with and without automatic tube compensation in ventilating patients with COPD . (4). To compare the outcome of the Smartcare and spontaneous breathing trails (SBT) for weaning patients with COPD.Methods (1). 21 patients with COPD were treated with IPPV ,BIPAP and autoflow.Parameters of resoiratory mechanics were recorded.(2).19 patients with COPD were treated with PSV . Parameters of resoiratory mechanics were recorded. (3). 38 patients with COPD were weaned with Smartcare and SBT.Results (1)The intrinsic positive end-expiratory pressure (PEEPi) in COPD is associated with the angle of peak expiratory flow and the end flow of expiratory. (2). BIPAP and autoflow can decrease the tracheal air pressure,improve the dynamic compliance of lung and increase the dead space .(3).The rapid of pressurization may decrease the inspiratory effort during pressure support ventilation in COPD patients. (4)The pressure ramp slop values has no effects on inspiration termination criteria during PSV. (5) PSV and ATC may increase the numbers of no-effective trigger and the numbers of high volume limited warning. (6)The Smartcare is better than SBT in weaning COPD men within 7 days.更多还原