俯卧位呼吸时是否悬空腹部对稳定期COPD患者呼吸动力学的影响

发布时间：2018-04-23 07:20

  本文选题：俯卧位 + 慢性阻塞性肺疾病　； 参考：《广州医科大学》2017年硕士论文

【摘要】：背景:慢性阻塞性肺疾病(简称慢阻肺COPD)是以气流不完全可逆受限为特征的慢性呼吸道疾病,是全世界范围内发病率和死亡率最高的疾病之一,是一种可以预防和可以治疗的常见病、多发病,但它严重危害人类的健康。其患病率大概占我国40岁以上人群的8.2%[1],预计2020年,全世界的COPD病死率将从1990年的第4位上升到第3位[2]。在20世纪70年代就有人提出俯卧位能改善通气及氧合的观点。美国危重病医学会第29届大会,大约有50%-75%的急性呼吸窘迫综合征(ARDS)患者在使用俯卧位通气(PPV)治疗后,动脉氧分压得到提高,而且吸入氧浓度有所下降。PPV在治疗重度ARDS已得到普遍认可,近些年国外有研究俯卧位通气的团队开始将目光投向COPD群体。但上述研究结果多为单中心、小样本的试验,其科学证据的强度不足以支持俯卧位通气对COPD患者治疗有效性。俯卧位是非生理性体位导致胸腹部受压,临床上应用俯卧位治疗能否扬长避短得到最大效果,为此本研究对比自主呼吸条件下俯卧位时是否悬空腹部对呼吸和循环动力学的影响,为临床提供参考依据。目的:探讨稳定期慢性阻塞性肺疾病(COPD)患者和健康志愿者在俯卧位状态下是否悬空腹部对呼吸动力学的影响。方法:12例稳定期COPD患者和9名健康志愿者随机顺序仰卧位(SP)、俯卧位悬空腹部(PAF)、俯卧位(PP)3种不同体位,每个体位均观察10 min,通过Nico和Bio Z无创心肺功能监测仪连续测定患者的呼吸和循环动力学指标,通过呼吸功能检测电极测定膈肌肌电、跨膈压(Pdi)等指标。结果:(1)呼吸动力学:健康志愿者PP的Pdi与PAF和SP比较显著升高[(13.5±1.6)比(11.5±2.2)、(10.1±1.7)cmH_2O(1 cmH_2O=0.098 kPa),P0.05],稳定期COPD患者PP的Pdi与PAF和SP比较明显升高[(22.6±2.5)比(15.6±2.6)(18.2±3.2)cmH_2O,P0.05];(2)循环动力学:健康志愿者PP的心指数(CI)显著高PAF和SP[(5.01±0.73)比(4.26±0.47)、(4.39±0.39)L/(min·m2),P0.01)],稳定期COPD患者SP的CI显著高于PAF和PP[(4.31±0.45)比(3.85±0.61)、(3.42±0.59)(L/min·m2),P0.01],外周血管阻力(SVRI)在PP时显著高于PAF[(1960.9±307.9)dyn·sec·cm-5.m2vs(1701.9±422.5)dyn·sec·cm-5.m2,P0.05)]结论:健康志愿者或稳定期COPD患者在俯卧位时悬空腹部,均能降低Pdi改善膈肌的运动能力,对稳定期COPD俯卧位时悬空腹部能减轻心脏的负荷。
[Abstract]:Background: chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by airflow incompletely reversible limitation. It is one of the highest morbidity and mortality in the world. It is a common disease that can be prevented and treatable. The prevalence rate of COPD is about 8.2% of the population over 40 years old in China. It is estimated that the mortality rate of COPD in the world will rise from the fourth place in 1990 to the third place [2] in 2020. In the 1970 s, it was suggested that prone position can improve ventilation and oxygenation. At the 29th Congress of the American Association of critical Care Medicine, about 50 to 75 percent of ARDS patients with acute respiratory distress syndrome were treated with prone position ventilation (PPVP), and the arterial partial pressure of oxygen was increased. It is generally recognized that oxygen inhalation concentration has decreased. PPV has been widely recognized in the treatment of severe ARDS. In recent years, some foreign teams who study prone position ventilation begin to focus on the COPD population. However, most of the above results were single-center, small-sample trials, and the scientific evidence was not strong enough to support the efficacy of prone position ventilation in the treatment of COPD patients. Prone position leads to chest and abdomen pressure in non-physiologic position. In this study, the effects of ventral suspension on respiratory and circulatory dynamics in prone position were compared to provide reference for clinical practice. Aim: to investigate the effects of abdominal suspension on respiratory dynamics in stable chronic obstructive pulmonary disease (COPD) patients and healthy volunteers in prone position. Methods 12 cases of stable COPD patients and 9 healthy volunteers were randomly assigned to lie on the supine position in the supine position, in the prone position in the suspended abdomen, and in the prone position in 3 different postures. The respiratory and circulatory parameters of patients were measured by Nico and Bio Z noninvasive cardiopulmonary function monitor, diaphragm myography and transdiaphragmatic pressure were measured by respiratory function detection electrode. Results (1) Respiratory dynamics: compared with PAF and SP, the Pdi of PP in healthy volunteers was significantly higher than that of PAF and SP [13.5 卤1.6] vs 11.5 卤2.2 cmH_2O=0.098 KPA (P0.05). The Pdi of PP in stable COPD patients was significantly higher than that of PAF and SP in stable COPD patients [22.6 卤2.5] vs 15.6 卤2.618.2 卤3.2cmH2OP] (P < 0.05) circulatory dynamics: the cardiac index of PP in healthy volunteers was significantly higher than that in healthy volunteers. (CI)鏄捐憲楂楶AF鍜孲P[(5.01卤0.73)姣，

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