摘要
本研究旨在评估慢性阻塞性肺疾病(COPD)患者鼻持续气道正压(nCPAP)对不同类型上气道或下气道阻塞的影响是否存在差异。对7例可逆性胸外上气道梗阻(RUAO)患者和3例固定式胸外上气道梗阻(FUAO)患者应用nCPAP (6cmh2o for ten min)治疗。18例稳定哮喘患者接受甲胆碱刺激,使FEV1降低20%以上,随机研究nCPAP或假压对可逆性下气道阻塞的影响。9名稳定的COPD患者被纳入研究对不可逆下气道阻塞的影响。在立即停用nCPAP之前和之后获得最大呼气流量和吸气流量曲线和呼吸困难评分。在RUAO组,nCPAP显著改善了喘鸣和呼吸困难评分,将FEF50/FIF50的比值从2.05 +/- 0.25降低到1.42 +/- 0.16,峰值吸气流量(PIF)和强迫吸气肺活量分别增加了26 +/- 8%和9 +/- 4%。在呼气期,肺功能无明显变化。在哮喘患者中,nCPAP显著逆转了甲基胆碱诱导的支气管收缩,肺活量增加10 +/- 3%,FEV1增加15 +/- 4%,PIF增加32 +/- 11%。nCPAP显著提高了对支气管扩张剂的反应。在nCPAP停药后,气流速率的改善持续至少5分钟,并且与对支气管扩张剂的反应高度相关。 There was no significant effect of nCPAP on airflow rate in COPD patients. Subjective dyspnoea score changes paralleled the pulmonary function improvement. We conclude that there are differential effects of nCPAP on airflow rates in patients with different nature of airway obstruction. Patients with airway obstruction caused by structural changes may not benefit from the use of nCPAP in improving airflow rates.