間歇正壓呼吸治療對於長期使用呼吸器病人在肺生理功能的短期效益

The Short-term Effects of Intermittent PositivePressure Breathing Therapy on LungMechanisms in Patients with ProlongedMechanical Ventilation

10.6269/JRT.2016.15.1.02

蕭秀鳳(Hsiu-Feng Hsia)；葉明珠(Ming-Chu Yeh)；李立夫(Li-Fu Li)；陳濘宏(Ning-Horn Chen)；高國晉(Kuo-Chin Kao)；陳妍慧(Yen-Huey Chen)

間歇正壓呼吸治療 ； 肺擴張治療 ； 肺功能 ； 抽痰量 ； 呼吸器依賴病人 ； intermittent positive pressure breathing ； lung expansion therapy ； pulmonary function ； secretion expectoration ； patients with prolonged mechanical ventilation.

呼吸治療

15卷1期（2016 / 01 / 01）

15 - 26

繁體中文

研究背景：長期使用呼吸器病人常因呼吸肌肉無力、肺容積降低、痰液蓄積等問題而脫離呼吸器失敗。間歇正壓呼吸治療(intermittent positive pressure breathing，IPPB)可協助病人預防肺塌陷及痰液清除。本研究目的為探討單次間歇正壓呼吸治療對於長期呼吸器病人在肺生理功能立即性之影響。研究方法：長期使用呼吸器病人隨機分為IPPB組(17人)、IPPB合併吐氣末正壓(PEEP)組(16人)、或對照組(17人)。治療組接受IPPB或IPPB合併PEEP治療20分鐘。治療前後測量肺生理功能：肺順應性、呼吸道阻力、肺功能等。並記錄治療中病人生命徵象及吐氣末二氧化分壓(end-tidal CO_2，etCO_2)。結果：痰液排除量呈組間顯著差異(ANOVA，p＜0.003)，且IPPB+PEEP組顯著高於其他2組。三組治療後生命徵象及肺容積無顯著差異。IPPB組治療後氣道阻力顯著下降(13.9±15.7 vs 6.2±3.1cm H2O/L/s，p＜0.05)。平均氣道壓則增加 (8.1±3.9 vs 9.7±1.7 cm H2O，p=0.05)。IPPB+PEEP 組及對照組治療前後肺生理參數無顯著差異。IPPB+PEEP組病人治療中etCO2下降(從38.1±6.5至36.5±6.2 cm H2O，p＜0.05)，其他組則無顯著變化。結論：本研究證實間歇正壓加吐氣正壓呼吸治療組相比較於間歇正壓組及控制組相，能促進長期使用呼吸器病人排痰量，降低吐氣末二氧化碳。我們亦發現間歇正壓治療長期使用呼吸器病人改善氣道阻力，提升氣體交換功能。對於有肺塌陷風險之長期使用呼吸器病人，可考慮執行間歇正壓呼吸治療或間歇正壓合併吐氣正壓治療。（呼吸治療2016;15 (1) 15-26）

BACKGROUND: Patients with prolonged mechanical ventilator (PMV) were often under great risk of atelectasis and retained section which are often the major cause of weaning failure. Intermittent positive pressure breathing (IPPB) has been reported to avoid atelectasis and mobilize secretion in patients with varied diagnosis. The purpose of this study is to investigate the short-term effects of IPPB on lung mechanics in patients with PMV. METHOD： Fifty patients with PMV were recruited from respiratory care center (RCC) and randomly assigned into IPPB (n=17), IPPB combined with PEEP (n=16), and control group (n=17). Both IPPB and IPPB combined with PEEP group received IPPB therapy for 20min. Before and after the treatment, the following variables were measured：.lung compliance, airway resistance, tidal volume (Vt), minute volume (MV), and wet sputum weight. The changes of vital sing and end-tidal CO_2 (etCO_2) were also recorded. RESULTS： After the intervention, neither vital signs nor lung volumes were different among 3 groups.. However, patients in IPPB group demonstrated significant improvement airway resistance (pre vs post： 13.9±15.7 vs 6.2±3.1 cm H_2O /L/s, p＜0.05), and mean airway pressure (pre vs post: 8.1±3.9 vs 9.7±1.7 cm H_2O, p＜0.05). The IPPB+PEEP group showed reduction in etCO_2 during the intervention (pre vs post 38.1±6.5 vs 36.5±6.2 cm H_2O, p＜0.05). CONCLUSION: The present study provides evidences that lung expansion therapy can result in improvement of lung mechanism and sequentially refine the function of gas exchange in patients with PMV. The benefits of IPPB may enhance the ventilator weaning success rate in patients with PMV.