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題 名 | Short-Term Effects of Nasal Pressure Support Ventilation in Acute Exacerbation of Hypercapnic COPD=使用鼻罩式呼吸器於慢性阻塞性肺疾併急性惡化之短程效果 |
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作 者 | 連德正; 王家弘; 吳宗靜; | 書刊名 | 中華醫學雜誌 |
卷 期 | 57:5 1996.05[民85.05] |
頁 次 | 頁335-342 |
分類號 | 415.415 |
關鍵詞 | 慢性阻塞性肺疾; 鼻罩式呼吸器; 非侵犯性呼吸器; 壓力支持; Chronic obstructive pulmonary disease; COPD; Nasal ventilation; Noninvasive ventilation; Pressure support; |
語 文 | 英文(English) |
中文摘要 | 背景 在慢性阻塞性肺疾併急性惡化之早期,如果鼻罩式壓力支持呼 吸器能儘早使用,將可避免延遲插管的併發症同時達成呼吸支持的效果。然而 據我們所知,目前還沒有研究將對象完全集中在此類病人身上。 方法 本前瞻性研究將BiPAP依不同設定分三階段使用於此類病人,每一階段 共30分鐘,第一階段為壓力支持(pressure support)10、PEEP 0 cmH2O,第二階段 為壓力支持10、PEEP 5 cmH2O,第三階段為壓力支持17、PEEP 5 cmH2O。使 用呼吸器前後各10分鐘為基準階段。 結果 本研究共收集10位病人,其中1位病人因無法忍受鼻罩很快退出研究, 且隨後因神智變差而插入氣管內管。其餘9位病人的資料顯示,第三階段的橫 膈肌電波、呼吸速率、潮氣末端二氧化碳值、潮氣容積/吸氣時間、每分鐘通氣 量都獲得有意義的降低(p值分別為0.0121,0.0026,0.0005,0.0116,0.0111), 潮氣容積與血氧飽和度也獲得明顯提升(p值分別為0.0265,0.0019)。第一階段 與第二階段的各項指標並無有意義的差別,用力吸氣及吐氣口壓在研究前後亦 無明顯改變。病人除了對於氣流與面罩有些不適外,並無明顯副作用。 結論 早期使用鼻罩式壓力支持呼吸器於慢性阻塞性肺疾併急性惡化時,短程 效果顯示,較高的壓力支持可有意義的降低吸氣肌肉活動性(activity)及呼吸驅動 (drive),同時可改善呼吸型態及氣體交換。呼吸肌肉力量無明顯改變,5cmH2O 的PEEP加在10cmH2O的壓力支持時並無明顯效果。 |
英文摘要 | Background. If nasal pressure support ventilation (NPSV) can be used at the early stage of acute exacerbation of severe COPD, profound ventilatory failure may be prevented without the complication from delayed intubation. To our knowledge, no study has focused on this group of patients. Methods. In this prospective study, BiPAP was used with three stages of settings each for 30 min as follows: pressure support (PS) 10 cmH2O without PEEP (stage 1), PS 10 & PEEP 5 cmH2O (stage 2), and PS 17 & PEEP 5 cmH2O (stage 3). Data of spontaneous breathing before and after NPSV each for 10 min were also recorded as baselines. Results. One of our 10 male patients dropped out due to intolerance of the mask, who was intubated immediately. Data of the other nine patients showed that integrated diaphragmatic EMG, respiratory rate, end-tidal CO2, VT/Ti, and VE reduced significantly when compared between baselines and stage 3 values (p = 0.0121, 0.0026, 0.0005, 0.0116, 0.0111 respectively). VT and SaO2 increased significantly (p = 0.0265 & 0.0019). The above parameters showed no significant difference between stage 1 and 2. Maximum inspiratory and expiratory mouth pressure remained unchanged after NPSV. No obvious complication was noted. Conclusions. For patients with acute exacerbations of severe COPD, early and short-term use of NPSV at higher level of PS can significantly suppress inspiratory muscle activities and respiratory drive, and improve VE, respiratory rate, gas exchange and thoracoabdominal asynchrony. Respiratory muscle strength changes little. The addition of 5 cmH2O of PEEP to 10 cmH2O of PS has no obvious effect. |
本系統中英文摘要資訊取自各篇刊載內容。