HEMODYNAMIC-EFFECTS OF PRESSURE SUPPORT AND PEEP VENTILATION BY NASAL ROUTE IN PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
HEMODYNAMIC-EFFECTS OF PRESSURE SUPPORT AND PEEP VENTILATION BY NASAL ROUTE IN PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
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DOI：
10.1136/thx.48.5.523
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发表时间：
1993-05-01
期刊：
影响因子：
10
通讯作者：
RAMPULLA, C
中科院分区：
文献类型：
--
作者：
AMBROSINO, N;NAVA, S;RAMPULLA, C
背景-通过鼻罩进行间歇性正压通气已被证明对治疗慢性呼吸功能不全很有用。压力支持通气是一种辅助通气模式，正越来越多地使用。间歇正压有创通气，有或无呼气末正压（PEEP），已被发现影响静脉回流和心输出量。本研究评价了鼻罩短时间压力支持通气的急性血流动力学效应，有和没有应用PEEP，严重稳定的慢性阻塞性肺疾病和高碳酸血症患者。方法-9例严重稳定型慢性阻塞性肺疾病患者在接受右心导管术进行临床检查时，进行了鼻罩压力支持通气，每次持续10分钟。评价以随机顺序，应用了四个阶段的鼻压力支持通气，包括。(1)吸气峰压（PIP）10 cm H_2O，PEEP 0 cm H_2O，（2）PIP 10 cm H_2O，PEEP 5 cm H_2O，（3）PIP 20 cm H_2O，PEEP 0 cm H_2O;（4）PIP 20 cm H2O，PEEP 5 cm H2O。结果-动脉血氧分压（PaO 2）和饱和度（SaO 2）显著增加，动脉二氧化碳分压（PaCO 2）显著降低用20 cm H2O的PIP观察pH的变化。统计学分析表明，增加5 cm H2O PEEP并没有进一步改善动脉血气张力。基线值与每次通气10分钟后测量值的比较表明，除PIP 10 cm H2O无PEEP外，所有通气模式均引起肺毛细血管楔压小幅但显著增加。与基线值相比，一个显着减少心输出量和氧输送诱导只有通过增加PEEP的两个水平的PIP. Conclusions，在严重的稳定的慢性阻塞性肺疾病和高碳酸血症患者，压力支持通气，除了由鼻罩提供的PEEP可能有短期的急性血液动力学效应，在减少氧输送，尽管足够的SaO 2水平。
Background-Intermittent positive pressure ventilation applied through a nasal mask has been shown to be useful in the treatment of chronic respiratory insufficiency. Pressure support ventilation is an assisted mode of ventilation which is being increasingly used. Invasive ventilation with intermittent positive pressure, with or without positive end expiratory pressure (PEEP), has been found to affect venous return and cardiac output. This study evaluated the acute haemodynamic effects of short sessions of pressure support ventilation by nasal mask, with and without the application of PEEP, in patients with severe stable chronic obstructive pulmonary disease and hypercapnia.Methods-Nine patients with severe stable chronic obstructive pulmonary disease performed sessions lasting 10 minutes each of pressure support ventilation by nasal mask while undergoing right heart catheterisation for clinical evaluation. In random order, four sessions of nasal pressure support ventilation were applied consisting of. (1) peak inspiratory pressure (PIP) 10 cm H2O, PEEP 0 cm H2O; (2) PIP 10 cm H2O, PEEP 5 cm H2O; (3) PIP 20 cm H2O, PEEP 0 cm H2O; (4) PIP 20 cm H2O, PEEP 5 cm H2O.Results-Significant increases in arterial oxygen tension (PaO2) and saturation (SaO2) and significant reductions in arterial carbon dioxide tension (PaCO2) and changes in pH were observed with a PIP of 20 cm H2O. Statistical analysis showed that the addition of 5 cm H2O PEEP did not further improve arterial blood gas tensions. Comparison of baseline values with measurements performed after 10 minutes of each session of ventilation showed that all modes of ventilation except PIP 10 cm H2O without PEEP induced a small but significant increase in pulmonary capillary wedge pressure. In comparison with baseline values, a significant decrease in cardiac output and oxygen delivery was induced only by the addition of PEEP to both levels of PIP.Conclusions-In patients with severe stable chronic obstructive pulmonary disease and hypercapnia, pressure support ventilation with the addition of PEEP delivered by nasal mask may have short term acute haemodynamic effects in reducing oxygen delivery in spite of adequate levels of SaO2.