TY - JOUR T1 -自滴定呼气末外气道正压消除严重COPD患者潮汐呼吸时的呼气流量限制:生理研究JF -欧洲呼吸杂志JO - Eur Respir J DO - 10.1183/13993003.02234- VL - 56 IS - 3 SP - 1902234 AU - Suh, Eui-Sik AU - Pompilio, Pasquale AU - Mandal, Swapna AU - Hill, Peter AU - Kaltsakas, Georgios AU - Murphy, Patrick B. AU - Romano, Robert AU - Moxham, John AU - Dellaca, Raffaele AU - Hart，Nicholas Y1 - 2020/09/01 UR - //www.qdcxjkg.com/content/56/3/1902234.abstract N2 -背景在COPD患者中，最佳的无创外呼气末正压(EPAP)应用以消除潮汐呼吸呼气流量限制(efft)并最小化内在呼气末正压(PEEPi)是具有挑战性的。我们研究了使用强制振荡技术(FOT)检测和消除EFLT的自动滴定EPAP是否会最大限度地减少严重COPD患者的PEEPi、呼吸功和神经呼吸驱动(NRD)。方法COPD合并慢性呼吸衰竭患者采用基于fot的EPAP自动滴定法检测efrt。一旦确定了最佳EPAP，进行手动滴定来评估NRD(分别使用膈肌和胸骨旁肋间肌肌电图，EMGdi和EMGpara)，横膈膜吸气压力波动(ΔPdi)，横膈膜压力-时间乘法(PTPdi)和PEEPi, EPAP水平低于最佳EPAP 2 cmH2O至高于最佳EPAP 3 cmH2O。10例入组患者(年龄65±6岁;男性60%;体重指数27.6±7.2 kg.m−2;用力呼气量在1秒内预测28.4±8.3%)，8例有EFLT，最佳EPAP为9(范围4-13)cmH2O。NRD在基线EPAP低于EMGdi的最佳EPAP 1 cmH2O和EMGpara的最佳EPAP时降低。此外，在最佳EPAP时，PEEPi(0.80±1.27 cmH2O vs 1.95±1.70 cmH2O; p<0.05) was reduced compared with baseline. PTPdi (10.3±7.8 cmH2O·s−1 versus 16.8±8.8 cmH2O·s−1; p<0.05) and ΔPdi (12.4±7.8 cmH2O versus 18.2±5.1 cmH2O; p<0.05) were reduced at optimal EPAP+1 cmH2O compared with baseline.Conclusion Autotitration of EPAP, using a FOT-based algorithm to abolish EFLT, minimises transdiaphragmatic pressure swings and NRD in patients with COPD and chronic respiratory failure.An automated ventilator algorithm, using the forced oscillation technique to detect tidal breathing expiratory flow limitation (EFLT), identifies the optimum EPAP at which EFLT is abolished without causing unnecessary lung hyperinflation https://bit.ly/2WNyhWP ER -