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目的比较成比例辅助通气(PAV)与双水平气道正压(BiPAP)通气对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者血流动力学参数的影响。方法COPD合并呼吸衰竭患者31例,给予常规内科治疗的同时,进行PAV和BiPAP通气各60min,监测患者在鼻导管吸氧自主呼吸以及接受不同通气模式支持时血流动力学参数、通气参数和动脉血气的变化。结果与自主呼吸相比,患者在BiPAP通气后心率(HR)和平均动脉压(MAP)略有下降,而在PAV通气时呈明显下降(P<0.05)。BiPAP通气时患者的心输出量(CO)、心脏指数(CI)、搏出量(SV)和每搏指数(SI)与PAV时相近,但低于未进行PAV时。PAV通气后射血前时间(PEP)明显缩短,对左室射血时间(LVET)则影响不大。PAV通气时的浅快呼吸指数(RR/VT)为81.2±4.7,显著高于BiPAP时的53.6±2.9(P<0.05)。PAV支持时的PaO2/FiO2较鼻导管吸氧时显著增高,PaCO2则有所降低。结论COPD呼吸衰竭患者接受PAV通气后,患者的血流动力学参数中CO、CI、SV等均明显下降,心输出量、心脏指数、搏出量和每搏指数明显改善,患者的心脏收缩能力得到增强。
Objective To compare the effects of proportional assisted ventilation (PAV) and bi-level positive airway pressure (BiPAP) ventilation on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods Thirty-one patients with COPD and respiratory failure were enrolled in this study. In addition to conventional medical therapy, PAV and BiPAP ventilation were performed for 60 minutes respectively. The hemodynamic parameters, ventilation parameters and arterial parameters were monitored during nasal spontaneous breathing with oxygen inhalation and with different ventilatory modes Blood gas changes. Results Compared with spontaneous respiration, patients’ heart rate (HR) and mean arterial pressure (MAP) decreased slightly after ventilation with BiPAP, but decreased significantly with PAV ventilation (P <0.05). Patients with BiPAP ventilation had similar cardiac output (CO), cardiac index (CI), stroke volume (SV) and stroke index (SI) at PAV but were lower than those without PAV. After PAV ventilation, the pre-ejection time (PEP) was significantly shortened, but had no significant effect on left ventricular ejection time (LVET). Pale-fast breathing index (RR / VT) at PAV ventilation was 81.2 ± 4.7, significantly higher than that of BiPAP at 53.6 ± 2.9 (P <0.05). PaO2 / FiO2 in PAV support was significantly higher than that in nasal catheter while PaCO2 was decreased. CONCLUSIONS: COPD patients with respiratory failure received PAV ventilation, the patient’s hemodynamic parameters of CO, CI, SV were significantly decreased, cardiac output, cardiac index, stroke volume and stroke index improved significantly, the patient’s cardiac contractility Be enhanced.