机械吸气-呼气过程中的压力变化对呼吸道和气道生理学的影响
Neeraj M Shah1, Chloe Apps2, Georgios Kaltsakas1
1Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, United Kingdom.
Chest
|October 16, 2023
概括
高压机械吸气-排气 (MIE) 能够有效地增加呼吸肌弱患者的咳,但可以导致上呼吸道关闭和不适,在那些有先进的弱点.
科学领域:
- 呼吸系统医学 呼吸系统医学
- 肺部病理学 肺部病理学
- 关键的护理关键的护理
背景情况:
- 呼吸道肌肉衰弱会影响咳,增加神经肌肉疾病中的感染风险.
- 机械吸气 - 排气 (MIE) 有助于咳,但最佳技术,特别是压力设置,需要进一步研究.
- 人们担心高压MIE (HP-MIE) 可能会导致肺部退役和呼吸道问题.
研究的目的:
- 为了比较高压MIE (HP-MIE) 与低压MIE (LP-MIE) 对肺部招募,呼吸驱动和患者舒适性的影响.
- 评估HP-MIE对上呼吸道功能和咳峰呼吸流 (CPEF) 的影响,患者有呼吸肌肉衰弱.
主要方法:
- 一项随机交叉研究,涉及29名患有呼吸道肌肉衰弱的患者 (杜申肌肉发育不良,脊髓损伤,长期通风).
- 患者接受LP-MIE (30/-30厘米H2O) 和HP-MIE (60/-60厘米H2O) 随机顺序.
- 测量包括肺部招募,神经呼吸驱动,CPEF,以及患者报告的舒适度和呼吸困难.
主要成果:
- 与LP-MIE相比,HP-MIE显著增加了CPEF (228对179L/分钟,P=.0001).与LP-MIE相比,HP-MIE显著增加了CPEF (228对179L/分钟,P=.0001).
- 在两种压力之间的肺部招募,神经呼吸驱动或呼吸困难方面没有发现显著差异.
- 然而,HP-MIE导致更严重的呼吸道肌肉衰弱患者的上呼吸道闭塞和不适增加.
结论:
- 与LP-MIE相比,HP-MIE可以增强咳功能,而不会对肺部的充血产生负面影响或引起呼吸困难.
- 由于上呼吸道关闭和不适感增加,高级呼吸道肌肉衰弱的患者对HP-MIE的耐受性很差.
- 单独的CPEF可能不足以指导HP-MIE定位,因为它不能完全捕捉潜在的不良影响,如上呼吸道关闭.
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