PHYSIOLOGICAL EVALUATION OF PRESSURE SUPPORT VENTILATION BY NASAL MASK IN PATIENTS WITH STABLE COPD
PHYSIOLOGICAL EVALUATION OF PRESSURE SUPPORT VENTILATION BY NASAL MASK IN PATIENTS WITH STABLE COPD
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DOI：
10.1378/chest.101.2.385
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发表时间：
1992-02-01
期刊：
影响因子：
9.6
通讯作者：
RAMPULLA, C
中科院分区：
文献类型：
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作者：
AMBROSINO, N;NAVA, S;RAMPULLA, C
我们对8例重度稳定期COPD合并慢性高碳酸血症患者随机分为两组，分别使用便携式呼吸机(Respironics BiPAP装置)和标准呼吸机(Bird 6400ST装置)，在吸气压力为22 cm H2O的条件下进行2小时的鼻腔压力支持通气(NPSV)。每名患者在连续两天的氧分压为0.21的情况下，与每台呼吸机进行两次治疗。一名患者对这两种通风方式都不耐受。比较自主呼吸机和BiPAP呼吸机，pH、PaCO2和PaO2均有显著改善。呼吸感应体积描记仪评估的呼吸模式显示每分钟通气量(VE)、VT和TTOT显著增加。仅在BiPAP机械通气时测得的综合表面肌电信号活动低于在自主呼吸时测得的。Bird 6400ST呼吸机在换气过程中，除VT/Ti值显著升高外，血气和呼吸模式也有类似的变化。在整个治疗周期的12小时后，比较基线和测量结果，发现pH和VE显著升高，PaCO2显著降低。我们的结论是，短期NPSV可能有助于改善稳定期COPD慢性高碳酸血症患者的呼吸模式和血气。
We evaluated the physiologic effects of pressure support ventilation by nasal route (NPSV) in eight patients with severe stable COPD and chronic hypercapnia who were randomly submitted to 2-h sessions of NPSV both with a portable ventilator (Respironics BIPAP device) and with a standard ventilator (Bird 6400ST device) at an inspiratory airway pressure of 22 cm H2O. Two sessions with each ventilator were performed using an FlO2 of 0.21 in each patient on two consecutive days. One patient did not tolerate either form of ventilation. Comparison of spontaneous with BIPAP ventilation showed a significant improvement in pH, PaCO2, and PaO2. Ventilatory pattern assessed by a respiratory inductive plethysmograph showed a significant increase in minute ventilation (VE), VT, and Ttot. Integrated surface diaphragmatic EMG activity measured only during BIPAP device ventilation decreased from that measured during spontaneous breathing. Similar changes in blood gases and ventilatory pattern were observed during ventilation by the Bird 6400ST except for VT/Ti ratio, which significantly increased. Comparison of baseline with measurements performed 12 h after the whole cycle of treatment showed a significant increase in pH and VE and a decrease in PaCO2. We conclude that short-term NPSV may be useful in improving respiratory pattern and blood gases in stable COPD patients with chronic hypercapnia.