老年慢性阻塞性肺疾病患者夜间中枢驱动及呼吸力学的变化

发布时间：2018-02-13 22:08

本文关键词： 慢性阻塞性肺疾病中枢驱动呼吸力学　出处：《中国老年学杂志》2014年01期 　论文类型：期刊论文

【摘要】：目的研究老年慢性阻塞性肺疾病(COPD)患者夜间睡眠状态下中枢驱动及呼吸力学的变化和关系。方法选择该院呼吸内科2009年3月至2012年3月住院的中、重度缓解期的COPD患者45例和本院人员健康组30例,所有患者测定呼吸中枢驱动、肺功能、气道阻力、血气分析等指标。结果 COPD患者在睡眠状态下吸气相第0.1秒口腔阻断压(P0.1)、膈肌肌电(MGdi%max)、潮气量(V T)、分钟通气量(V E)、平均吸气流量(V T/Ti)、膈肌电电压均方根(RMS)和脉搏血氧饱和度(SpO2)有显著性降低(P0.05或P0.01);呼气末二氧化碳分压(PETCO2)睡眠状态有显著性的升高(P0.05);呼吸频率(RR)和吸气时间占呼吸周期比值(Ti/TTOT)无显著性差异,(P0.05)。对照组各项指标睡眠状态和清醒状态均无显著性变化(P0.05)。结论老年COPD患者夜间睡眠呼吸力学异常,主要表现为气道阻力异常增高,呼吸肌力量减弱,呼吸做功显著增加,同时伴有中枢驱动和通气需求的降低;呼吸中枢驱动较清醒时显著下降,可能是造成患者夜间睡眠出现低通气、低氧血症、呼吸困难甚至是呼吸衰竭的重要原因之一。
[Abstract]:Objective to study the changes and relationship between central drive and respiratory mechanics in elderly patients with chronic obstructive pulmonary disease (COPD) during night sleep. 45 COPD patients in severe remission period and 30 healthy people in our hospital were enrolled in this study. Respiratory drive, pulmonary function, airway resistance were measured in all patients. Results Blood gas analysis was performed in patients with COPD. Results in patients with COPD, oral occlusion pressure (P0.1), diaphragm myoelectricity (MGdimax), tidal volume (VT), minute ventilation volume (VEN), mean inspiratory flow (VT), diaphragm electrical voltage (RMS) and pulse blood were measured at 0.1 second of inspiratory phase during sleep. Oxygen saturation (SPO _ 2) decreased significantly (P 0.05 or P 0.01); end expiratory carbon dioxide pressure (PETCO _ 2) increased significantly (P 0.05); RR) and the ratio of inspiratory time to respiratory cycle were not significantly different (P 0.05). There were no significant changes in the state of sleep and waking state. Conclusion the sleep mechanical abnormality of the elderly patients with COPD at night is not significant (P 0.05). The main manifestations were increased airway resistance, decreased respiratory muscle strength, increased respiratory work, and decreased central drive and ventilation requirements. It may be one of the important causes of hypopnea, hypoxemia, dyspnea and even respiratory failure.
【作者单位】：新疆医科大学第六附属医院呼吸内科;新疆医科大学第六附属医院神经内科;新疆医科大学第六附属医院风湿血液科;
【分类号】：R563.9

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