本文選題：俯臥位 + 慢性阻塞性肺疾病��； 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:慢性阻塞性肺疾病(簡稱慢阻肺COPD)是以氣流不完全可逆受限為特征的慢性呼吸道疾病,是全世界范圍內(nèi)發(fā)病率和死亡率最高的疾病之一,是一種可以預(yù)防和可以治療的常見病、多發(fā)病,但它嚴(yán)重危害人類的健康。其患病率大概占我國40歲以上人群的8.2%[1],預(yù)計2020年,全世界的COPD病死率將從1990年的第4位上升到第3位[2]。在20世紀(jì)70年代就有人提出俯臥位能改善通氣及氧合的觀點(diǎn)。美國危重病醫(yī)學(xué)會第29屆大會,大約有50%-75%的急性呼吸窘迫綜合征(ARDS)患者在使用俯臥位通氣(PPV)治療后,動脈氧分壓得到提高,而且吸入氧濃度有所下降。PPV在治療重度ARDS已得到普遍認(rèn)可,近些年國外有研究俯臥位通氣的團(tuán)隊開始將目光投向COPD群體。但上述研究結(jié)果多為單中心、小樣本的試驗,其科學(xué)證據(jù)的強(qiáng)度不足以支持俯臥位通氣對COPD患者治療有效性。俯臥位是非生理性體位導(dǎo)致胸腹部受壓,臨床上應(yīng)用俯臥位治療能否揚(yáng)長避短得到最大效果,為此本研究對比自主呼吸條件下俯臥位時是否懸空腹部對呼吸和循環(huán)動力學(xué)的影響,為臨床提供參考依據(jù)。目的:探討穩(wěn)定期慢性阻塞性肺疾病(COPD)患者和健康志愿者在俯臥位狀態(tài)下是否懸空腹部對呼吸動力學(xué)的影響。方法:12例穩(wěn)定期COPD患者和9名健康志愿者隨機(jī)順序仰臥位(SP)、俯臥位懸空腹部(PAF)、俯臥位(PP)3種不同體位,每個體位均觀察10 min,通過Nico和Bio Z無創(chuàng)心肺功能監(jiān)測儀連續(xù)測定患者的呼吸和循環(huán)動力學(xué)指標(biāo),通過呼吸功能檢測電極測定膈肌肌電、跨膈壓(Pdi)等指標(biāo)。結(jié)果:(1)呼吸動力學(xué):健康志愿者PP的Pdi與PAF和SP比較顯著升高[(13.5±1.6)比(11.5±2.2)、(10.1±1.7)cmH_2O(1 cmH_2O=0.098 kPa),P0.05],穩(wěn)定期COPD患者PP的Pdi與PAF和SP比較明顯升高[(22.6±2.5)比(15.6±2.6)(18.2±3.2)cmH_2O,P0.05];(2)循環(huán)動力學(xué):健康志愿者PP的心指數(shù)(CI)顯著高PAF和SP[(5.01±0.73)比(4.26±0.47)、(4.39±0.39)L/(min·m2),P0.01)],穩(wěn)定期COPD患者SP的CI顯著高于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時顯著高于PAF[(1960.9±307.9)dyn·sec·cm-5.m2vs(1701.9±422.5)dyn·sec·cm-5.m2,P0.05)]結(jié)論:健康志愿者或穩(wěn)定期COPD患者在俯臥位時懸空腹部,均能降低Pdi改善膈肌的運(yùn)動能力,對穩(wěn)定期COPD俯臥位時懸空腹部能減輕心臟的負(fù)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 鹵1.6] vs 11.5 鹵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 鹵2.5] vs 15.6 鹵2.618.2 鹵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鹵0.73)姣，

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