沙丁胺醇联合呼气末正压通气对COPD患者生理功能的影响

摘要

OBJECTIVE: To observe the effective of combination salbutamol and external positive end-expiratory pressure (PEEPe) may present additive benefits in chronic obstructive pulmonary disease (COPD) exacerbation. METHODS: In 10 mechanically ventilated, and bronchodilator-responsive COPD patients exhibiting moderate intrinsic PEEP (PEEPi), we assessed respiratory system mechanics, hemodynamics, and gas exchange at Intubation 30 min(ZEEPe- Ⅰ ), 30 min after (ZEEPe-S), from 8 h after 5 mg of nebulized salbutamol administration to 15 min before PEEPe (ZEEPe- Ⅱ), 30 min after setting PEEPe at baseline PEEPi level (PEEPe-30) , and 30 min after 5 mg of nebulized salbutamol administration with PEEPe maintained unchanged (PEEPe-S). Return of determined variable values to baseline values was confirmed before PEEPe application. RESULTS: Compared with ZEEPe-1 , the Rmax,Rmin,AR,AFRC,PEEPi, PCWP and SVR were lower(P<0.01); HR,SvO2 and DO2 were higher (P<0.01); In PEEPe-30, the PEEPi, PaCO2, Qs/Qt were lower(P<0.01); In PEEPe-S, Rmax,Rmin,AFRC,PCWP,Qs/Qt and SVR was lower (P<0.01); HR, DO2 and PaO2 were higher (P<0.01).CONCLUSION: In carefully preselected COPD patients, Nebulized Salbutamol combined with PEEPe exhibits additive benefits.%目的:观察沙丁胺醇联合外源性呼气末正压通气(PEEPe)对慢性阻塞性肺疾病(COPD)患者生理功能的影响.方法:将对支气管扩张剂有反应性,伴有中度内源性呼气末正压通气(PEEPi)的机械性通气COPD患者10例,分别在插管后30 min(ZEEPe-Ⅰ),雾化吸入5 mg沙丁胺醇后30 min (ZEEPe-S),首次雾化吸入沙丁胺醇后8h到PEEPe通气前的15 min(ZEEPe-Ⅱ),在基础水平PEEPi上设置PEEPe后30 min (PEEPe-30),雾化吸入5mg沙丁胺醇和PEEPe结合治疗后30 min(PEEPe-S)时,评测患者的呼吸系统力学、血液动力学和气体交换功能.在PEEPe通气前检测确定变量的基础值.结果:与ZEEPe-Ⅰ时间点比较,ZEEPe-S时间点最大总呼气阻力、最小呼吸阻力、附加肺呼吸阻力、功能残气量的变化、PEEPi、肺毛细血管楔压和全身血管阻力均显著降低(P＜0.01),心率、混合静脉血氧饱和度和氧输送量显著提高(P＜0.01)；在PEEPe-30治疗时间点PEEPi、二氧化碳分压和静脉血掺杂比显著降低(P＜0.01)；在PEEPe-S时间点最大总呼气阻力、最小呼吸阻力、功能残气量的变化、肺毛细血管楔压、静脉血掺杂比和全身血管阻力显著降低(P＜0.01),心率、氧输送量和动脉血氧分压显著提高(P＜0.01).结论:对于有中度PEEPi-COPD患者,沙丁胺醇联合PEEPe有累加的治疗作用.