摘要
目的探讨不同腹腔压力状态下COPD患者机械通气、呼吸力学改变,以及降低腹腔压力的护理措施。方法采用前瞻性对照研究的方法,将58例因COPD呼吸衰竭行气管插管机械通气的患者,用RM6240-C型多导生理信号采集系统监测腹腔压力(IAP),并根据IAP的不同,分为IAH组和IAP正常组,在不同机械通气参数下,比较2组患者的气道峰压、气道平均压、分钟通气量、肺顺应性等呼吸力学指标的变化,并对IAH组患者采取降低IAP的治疗和护理措施后,用自身前后对照的方法,比较处理前后的IAP的变化。结果与IAP正常组对比,IAH组患者的平均气道压、气道峰压增高(P<0.05),静态肺顺应性下降(P<0.05);与IAP正常的患者相比,给予IAH组患者较高的PEEP值产生的呼吸力学指标的这种不良影响更为明显,差异有统计学意义(P <0.05)。降低IAP的措施可以改善上述呼吸力学指标。结论 IAH会引起机械通气患者气道峰压、气道平均压增加和分钟通气量、肺顺应性下降,降低IAP的治疗和护理措施有利于减少腹腔压力对机械通气的影响。
Objective To explore the changes of mechanical ventilation and respiratory mechanics in patients with COPD under different abdo minal pressure and the nursing measures to reduce abdominal pressure. Methods 58 patients with COPD respiratory failure due to tracheal intubation were monitored by a prospective control study. The abdominal pressure（ IAP ） was monitored with a RM6240-C multi guide physiologicat signal acquisition system. According to the difference of IAP, the patients were divided into IAH group and normal IAP group. Under the different mechanical ventilation parameters ,the patients were compared with those of the 2 groups. The changes of respiratory mechanics indexes such as peak pressure of airway, mean airway pressure, minute ventilation, lung compliance, and the treatment and nursing measures of reducing IAP in the IAH group were taken, and the changes of IAP before and after treatment were compared with their own before and after treatment. Results compared with the normal IAP group,the average airway pressure,the airway peak pressure increased（P〈0.05） and the static lung compliance decreased（P〈0.05） in the IAH group. Compared with the normal IAP patients,the adverse effects of the higher PEEP values in the IAH group were more significant（P〈0.05）. Measures to reduce IAP can improve the above respiratory mechanics indexes. Conclusion IAH can cause the airway peak pressure, the increase of mean airway pressure, the minute ventilation and the decrease of lung compliance. The treat- ment and nursing measures of reducing IAP are beneficial to reduce the effect of abdominal pressure on mechanical ventilation.
基金
天津市卫生局科技基金(编号:2011KY29)
关键词
慢性阻塞性肺疾病
腹腔压力
机械通气
护理
Chronic obstructive pulmonary disease
Abdominal cavity pressure
Mechanical ventilation
Nursing
