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Article(id=1206995863314973040, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1206995859061952854, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.12.1262, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1629043200000, receivedDateStr=2021-08-16, revisedDate=null, revisedDateStr=null, acceptedDate=1635436800000, acceptedDateStr=2021-10-29, onlineDate=1765699838712, onlineDateStr=2025-12-14, pubDate=1672156800000, pubDateStr=2022-12-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1765699838712, onlineIssueDateStr=2025-12-14, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1765699838712, creator=13701087609, updateTime=1765699838712, updator=13701087609, issue=Issue{id=1206995859061952854, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='12', pageStart='1169', pageEnd='1270', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1765699837699, creator=13701087609, updateTime=1765700204449, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1206997397385859947, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1206995859061952854, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1206997397385859948, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1206995859061952854, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1262, endPage=1267, ext={EN=ArticleExt(id=1206995863637934456, articleId=1206995863314973040, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress of respiratory mechanics monitoring in guiding mechanical ventilation of patients with COPD, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Chronic obstructive pulmonary disease (COPD) is a common pulmonary disease in elderly, in which the pulmonary respiratory mechanics has gradually changed, while surgery, general anesthesia and conventional mechanical ventilation will seriously affect the pulmonary respiratory mechanics of COPD patients, which are more likely to have severe perioperative pulmonary complications. Therefore, according to the features of the respiratory mechanics of COPD patients and the characteristics of changes in respiratory mechanics during mechanical ventilation, to select individualized ventilation strategies to improve their respiratory mechanics and apply different monitoring methods to optimize the interaction between human and ventilator during ventilation of COPD patients for achieving the purpose of lung protection are very important for patients with COPD during the perioperative period. This review describes in detail the physiological status of the patients with COPD patients and the characteristics of respiratory mechanics during mechanical ventilation, and through the summary and discussion of recent literature, describes different ventilation strategies and various respiratory mechanics monitoring methods in COPD patients in recent years. It is expected to provide new ideas and references for the ventilation management of COPD patients who require mechanical ventilation in clinical practice.

, correspAuthors=Ying-Bin Wang, authorNote=null, correspAuthorsNote=
*E-mail:
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慢性阻塞性肺疾病(COPD)是一种常见的老年肺部疾病，主要表现为肺部呼吸力学发生改变；而手术麻醉或常规机械通气会导致肺部呼吸力学的进一步变化，易发生严重的肺部并发症。因此，根据COPD患者的呼吸力学特点及机械通气时呼吸力学的改变，选择个体化的通气策略、采取不同的呼吸力学监测方式优化人机相互作用以达到肺保护的目的，对于COPD患者至关重要。本文对COPD患者生理状态下和机械通气时的呼吸力学特点以及不同呼吸力学监测方式的应用进展进行综述，以期为临床COPD患者的机械通气管理提供参考。

, correspAuthors=王迎斌, authorNote=null, correspAuthorsNote=
王迎斌，E-mail：
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钟海莲，硕士研究生，主要从事围术期器官保护方面的研究

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钟海莲，硕士研究生，主要从事围术期器官保护方面的研究

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钟海莲，硕士研究生，主要从事围术期器官保护方面的研究

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呼吸力学监测指导COPD患者机械通气的研究进展
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钟海莲 , 王迎斌 *
解放军医学杂志 | 综述 2022,47(12): 1262-1267
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解放军医学杂志 | 综述 2022, 47(12): 1262-1267
呼吸力学监测指导COPD患者机械通气的研究进展
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钟海莲, 王迎斌*
作者信息
  • 兰州大学第二医院麻醉科，甘肃兰州 730030

    • 钟海莲，硕士研究生，主要从事围术期器官保护方面的研究

通讯作者:

王迎斌，E-mail：
Research progress of respiratory mechanics monitoring in guiding mechanical ventilation of patients with COPD
Hai-Lian Zhong, Ying-Bin Wang*
Affiliations
  • Department of Anesthesiology, the Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
出版时间: 2022-12-28 doi: 10.11855/j.issn.0577-7402.2022.12.1262
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摘要
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慢性阻塞性肺疾病(COPD)是一种常见的老年肺部疾病，主要表现为肺部呼吸力学发生改变；而手术麻醉或常规机械通气会导致肺部呼吸力学的进一步变化，易发生严重的肺部并发症。因此，根据COPD患者的呼吸力学特点及机械通气时呼吸力学的改变，选择个体化的通气策略、采取不同的呼吸力学监测方式优化人机相互作用以达到肺保护的目的，对于COPD患者至关重要。本文对COPD患者生理状态下和机械通气时的呼吸力学特点以及不同呼吸力学监测方式的应用进展进行综述，以期为临床COPD患者的机械通气管理提供参考。

慢性阻塞性肺疾病  /  机械通气  /  呼吸力学  /  指导

Chronic obstructive pulmonary disease (COPD) is a common pulmonary disease in elderly, in which the pulmonary respiratory mechanics has gradually changed, while surgery, general anesthesia and conventional mechanical ventilation will seriously affect the pulmonary respiratory mechanics of COPD patients, which are more likely to have severe perioperative pulmonary complications. Therefore, according to the features of the respiratory mechanics of COPD patients and the characteristics of changes in respiratory mechanics during mechanical ventilation, to select individualized ventilation strategies to improve their respiratory mechanics and apply different monitoring methods to optimize the interaction between human and ventilator during ventilation of COPD patients for achieving the purpose of lung protection are very important for patients with COPD during the perioperative period. This review describes in detail the physiological status of the patients with COPD patients and the characteristics of respiratory mechanics during mechanical ventilation, and through the summary and discussion of recent literature, describes different ventilation strategies and various respiratory mechanics monitoring methods in COPD patients in recent years. It is expected to provide new ideas and references for the ventilation management of COPD patients who require mechanical ventilation in clinical practice.

chronic obstructive pulmonary disease  /  mechanical ventilation  /  respiratory mechanics  /  guiding
钟海莲, 王迎斌. 呼吸力学监测指导COPD患者机械通气的研究进展. 解放军医学杂志, 2022 , 47 (12) : 1262 -1267 . DOI: 10.11855/j.issn.0577-7402.2022.12.1262
Hai-Lian Zhong, Ying-Bin Wang. Research progress of respiratory mechanics monitoring in guiding mechanical ventilation of patients with COPD[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (12) : 1262 -1267 . DOI: 10.11855/j.issn.0577-7402.2022.12.1262
正文
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慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)是一种进行性的气道、肺泡和微血管炎症性疾病，其关键特征是持续气流受限，不可完全逆转[1]。目前COPD居全球死亡原因第4位，预计2030年将升至第3位[2-3]。临床上因呼吸衰竭或手术需行机械通气的COPD患者日益增多，而COPD是围术期肺部并发症(perioperative pulmonary complications，PPCs)的高危因素，COPD患者中PPCs的发生率为26%~78%[4]；围术期发生症状明显的支气管痉挛，可增高围术期死亡率[5]，发生PPCs的患者30 d病死率高达20%[6]。故通过监测呼吸力学、制定个体化的通气策略、减轻呼吸机相关性肺损伤(ventilator-induced lung injury，VILI)及降低PPCs发生率以达到肺保护的目的，对围术期合并COPD的患者至关重要。本文对COPD患者生理状态下和机械通气时的呼吸力学特点以及不同呼吸力学监测方式的应用进展进行综述，以期为临床COPD患者的机械通气管理提供新的参考。
1 COPD患者生理状态下的呼吸力学特点
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COPD患者发生小气道和肺实质的慢性炎症，导致阻塞性毛细支气管炎、肺实质破坏和肺气肿[7]。小气道阻塞和肺气肿导致气道阻力增加及弹性回缩力减小，从而导致气流受限，气道在呼气末保持开放的能力受损[8]。根据伯努利原理，在较高的呼气流量期间，气体对气道壁施加的压力较低，若导管不是刚性的，当流量达到一定速度时就会塌陷，限制呼气流量的进一步增加[9]。呼气末气道塌陷可导致肺泡回缩障碍、弹性日益减退、剩余呼气末容积增加、动态恶性充气(dynamic hyperinflation，DH)及内源性呼气末正压(intrinsic positive end-expiratory pressure，PEEPi)[10]。由于阻塞的程度不同，PEEPi并非均匀地分布在整个肺中，而是与各个肺单元中存在的气道阻力呈正比，最终导致COPD患者的通气不均一性(ventilation heterogeneity，VH)[9]。
2 COPD患者机械通气时的呼吸力学特点
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机械通气是非生理性的，由于镇静、麻醉、手术、体位变化，以及机械通气本身造成的胸壁和膈肌力学变化，扰乱了肺的生理功能，导致肺不张、气体交换障碍及通气/血流比例失调，使患者处于生理与病理之间的某种状态，这些变化对大多数患者几乎没有临床影响。然而，潜在的疾病可能会放大肺部的这些变化，尤其COPD患者肺组织本身存在持续性炎症反应，手术伤害性刺激及麻醉可能会作为“二次打击”导致其预后不良[11-12]。
另有研究发现，机械通气可通过激发预先存在的局部炎症反应，诱发术后急性肺损伤和急性呼吸窘迫综合征，该过程也会造成“二次打击”[13-14]。机械通气时不恰当的气道压、容积及剪切力(第二次打击)，致使COPD患者容易发生气压伤、萎陷伤和生物伤，从而发生VILI[15]。故了解COPD患者机械通气时的呼吸力学情况，在呼吸力学监测指导下选择适宜的通气策略，降低或尽可能降低手术伤害性刺激及麻醉与通气本身导致的负面效果，有利于改善COPD患者的预后。
机械通气吸气期，过高的压力和过大的容积可导致吸气末经肺压力增高，进一步导致肺泡过度扩张。较高的驱动压力会导致呼吸肌疲劳并增加COPD患者呼吸困难的发生率。而在低呼气气道压力和容积下，不稳定的肺泡可随着每次呼吸而反复打开和塌陷，导致肺泡和远端小气道实质剪切损伤及其表面活性物质功能障碍[16]。因此，关注潮气量及经肺驱动压，实现肺不张与过度肺扩张之间的有效平衡，能最大限度地降低VILI的发生风险[17]。
COPD患者机械通气时，在没有呼气末正压的情况下，被动呼气期间(即没有主动呼气努力)排空肺所需的时间遵循指数衰减，该指数衰减取决于呼吸系统的顺应性与阻力的乘积(即时间常数)。在这种情况下，当呼气时间低于3~4个时间常数时，吸入的潮气量不能完全呼出，呼气末容积高于舒张容积，可导致过度充气和呼气末弹性回缩压力增加，即PEEPi。可通过减小气道或呼吸机回路中的呼气阻力、延长呼气时间或减少每分钟通气量来减轻由不完全呼气产生的PEEPi[9]。
在机械通气时，COPD患者产生的空气潴留、PEEPi及DH都会造成肺和胸部的容积增加，吸气末期肺泡和胸膜压力增大，这可能会增大肺血管阻力、右心室后负荷和右心房压力，导致心输出量减少，并最终损害氧气输送[10]。此外，PEEPi可通过产生吸气阈负荷显著增加呼吸功，会使膈肌变平及收缩功能降低，并加重膈肌损伤[9]。另有研究发现，DH是导致胸内压升高、呼吸功增加、呼吸机依赖及脱机失败的主要因素[16]。
3 基于呼吸力学监测指导改善COPD患者机械通气
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根据COPD患者的呼吸力学特点，对于围术期COPD机械通气患者，建议及时监测呼吸力学参数(如顺应性、空气潴留、DH、VH、PEEPi等)，同时考虑使用外源性呼气末正压(extrinsic positive end-expiratory pressure，PEEPe)，调整通气策略，以优化呼吸力学。
3.1 潮气量
小潮气量(6~8 ml/kg)通气有利于限制肺泡(平台)峰压低于30 cmH2O，降低VILI的发生率，对于COPD患者还可预防过度通气[15,18]。低潮气量合并低吸呼比的策略有利于使过度膨胀的肺排空，且这种方法不易引起碱血症、加重DH和PEEPi，也不会过度扩张通气的肺泡单位。研究发现，与常规机械通气组(潮气量10 ml/kg)相比，术中低潮气量组的肺气道峰压、平台压、气道阻力较低，顺应性、血氧饱和度较高[19-20]。Park等[21]通过多变量分析发现，低潮气量通气可有效降低COPD患者发生PPCs的风险。
3.2 呼吸频率
降低呼吸频率和增加吸气流量可延长呼气时间，促进肺排空。高吸气流量有利于降低吸呼比，延长呼气时间[10]。降低吸呼比(1:3甚至1:5)即延长呼气时间、缩短吸气时间增加了峰值吸气流量，有利于所有肺泡更好地通气[22]。尽可能低的呼吸频率(如6~10次/min)可降低呼吸功，有利于降低VILI的发生率，只要患者血流动力学稳定或不属于高危人群(如孕妇、颅内高压或肺动脉高压患者)，在低呼吸频率下可允许高碳酸血症(pH>7.2)的存在[18,23]。但根据等压点或伯努利理论，当发生阻塞点时，气道阻力会突然增大，呼气流量会显著减少。呼气末正压通气期间的呼气流量相对较低，延长呼气时间仅能获得少量额外呼气量，此时降低呼吸频率可能会造成患者通气不足[9]。故需要综合评估低呼吸频率带来的优势，合理调整，避免患者预后不良。
3.3 跨肺压与驱动压
跨肺压和驱动压的概念已越来越多地用于量化机械通气期间作用于肺部的机械力，反映了机械通气时整体肺对机械力的应变，有助于评估VILI[24-25]。跨肺压作为直接扩张肺组织的压力，为肺泡压与胸腔压的差值，代表施加到肺实质的应力，临床上常以食管压替代胸腔压来估计跨肺压[24]。有研究表明，对于均匀肺实质患者跨肺压应保持在低于15~20 cmH2O，而不均匀肺实质患者则应保持在低于10~12 cmH2O[26]。驱动压为平台压减去PEEPe，其指导的肺保护性通气策略有利于降低PPCs[27]。有研究发现，驱动压在8~12 cmH2O时对于COPD患者是相对安全的[28]。
3.4 通气模式
与容量控制通气(volume-controlled ventilation，VCV)相比，压力控制通气(pressure-controlled ventilation，PCV)具有较低的气道峰压、较好的肺顺应性和氧合指数[19,29]。即使呼吸机设置相同，机械功率也可能不同，VCV的机械功率可能高于PCV，这是由于在PCV中，气道峰压相当于平台压，而在VCV中，由于阻力分量，气道峰压高于平台压。在PCV模式中，初始气流流速高，易打开陷闭的肺泡，且由于其减速的流量，降低了气道峰压，允许潮气量更均匀地分布，并改善静态和动态肺顺应性[23]。目前，新型通气模式——压力控制容量保证模式(pressure-controlled ventilation volume-guaranteed，PCV-VG)已得到广泛应用，该模式结合了PCV的优势并保证了一定的通气量，代表机型有Avance麻醉机(Datex-Ohmeda公司，美国)、BIRD 8400STi呼吸机(鸟牌公司，美国)等。在COPD患者中应用PCV-VG模式，在确保改善通气、提高氧合的同时，还能维持低吸气气道正压和气道峰压，降低肺损伤的发生风险。研究认为，PCV-VG是较VCV更安全的保护性通气模式[30]。但也有研究认为，不同控制通气模式下患者PPCs的发生率并无显著差异[31]。故对于通气模式的选择仍需结合更多的监测手段继续探讨。
3.5 呼吸肌监测
DH会导致膈肌变平，使其收缩功能降低，并加重膈肌损伤[9]。研究显示，肺超声测量的膈肌偏移度和厚度与COPD患者的病情严重程度及预后明显相关，且膈肌越短，患者预后越差[32-33]。
3.6 DH与VH
COPD机械通气时存在空气潴留(剩余容量增加，剩余容量与总肺容量之比增加)、DH(总肺容量增加)及VH(部分肺泡过度通气，部分肺泡萎陷不张)，可产生肺部气压伤和容积伤，影响血流动力学，并最终影响氧气输送[22]。
现阶段已有研究采用不同的监测方法来优化通气。电阻抗断层成像(electrical impedance tomography，EIT)是一种功能性无辐射成像技术，可通过计算相应区域的阻抗变化来测量时间和空间上的区域肺通气分布，测量肺容量与吸气呼气流量的变化，分析局部呼吸力学的变化[34]。EIT能够连续测量肺部容积的变化，计算呼气末和吸气末总阻抗变化，进而评估COPD患者是否有呼气末排气不完全以及DH的严重程度。研究发现，与健康受试者相比，COPD患者通过EIT测得的VH相关指数(通气中心指数，代表沿通气方向的通气分布；整体不均匀性指数，量化肺部区域内潮气量的通气分布)明显增高[35]。COPD患者通常会因气道阻塞或黏液生成增加而出现通气延迟，VH也会延迟向肺泡输送空气，高分辨率的EIT能够捕捉这种延迟现象，临床上可通过调整通气策略来减轻这种时间延迟。在对COPD患者进行药物治疗时发现，EIT测得的局部呼气末流量可用于评估是否有局部空气潴留及潴留情况[36]，区域局部呼气末流量直方图显示，用药前局部呼气末流量具有较高的空间不均一性，治疗1 d后空间不均一性减轻，局部呼气末流量下降。因此，EIT可测量评估COPD患者复杂的呼吸力学变化，优化监测信息，有助于临床医师为COPD患者选择合适的通气策略。
光电体积描记术(optoelectronic plethysmography，OEP)是一种可准确和有效测量肺容积及胸壁运动的方法。OEP通过三维建模模拟胸腹壁表面积及胸腹腔容积，从而监测患者在呼吸过程中胸腹壁的运动轨迹及肺容积的变化。通过OEP监测发现，COPD患者在运动过程中胸腹壁运动轨迹及容积变化不同步，且存在DH的患者在运动过程中呼气末容积持续上升[37]。因此，OEP不仅可评估COPD患者的呼吸力学变化，而且在指导COPD患者机械通气方面具有巨大的应用潜力。
超声作为一种非侵入性的肺部监测方法已被用于监测呼吸力学的改变，低频超声检查(low frequency ultrasound，LFU)用于监测呼吸时，其吸气和呼气相的声谱信号不同，肺通气量越大，声谱信号越弱，高通滤波器向更高的频率移动，可用于监测COPD患者的空气潴留及DH。一项研究定义吸气呼气相超声信号所产生的频率差值为ΔF，发现健康受试者与COPD患者的ΔF值差异显著[38]，其显著性随着COPD的严重程度加重而增加。LFU检测COPD患者空气潴留的灵敏度GOLD 1级为83.3%，GOLD 2/3级为90.9%，对任一分级的COPD患者空气潴留的检测特异度为88.9%。
3.7 PEEPi
3.7.1 PEEPi的监测
PEEPi指呼气末弹性回缩压力的增加，与DH导致的呼气末肺容积超过静息肺容积有关[10]。目前有多种方法可用于监测机械通气患者的PEEPi。在可行呼气暂停的呼吸机或麻醉机上，无自主呼吸患者通气时，呼气结束暂停2 s后压力上升到总呼气末正压水平，然后用总呼气末正压减去PEEPe可计算PEEPi。在配备波形图监测的通气设备上，观察到流量曲线未返回零(即压力-时间曲线、流量-时间曲线及压力-容积曲线等呼气流量在下一次吸气前没有恢复到零)和二氧化碳描记图有进一步上升的痕迹时，即存在PEEPi[16,22,39]。呼气末流量为零时的肺泡压等于PEEPi，临床中常用食管测压法，在呼气暂停后所测得的气道阻断压(即食管球囊测得的食管压)近似于肺泡压，此时的食管压即近似于PEEPi[26]。另外，胸膜压力的较大变化可传递到胸内血管并通过中心静脉压或肺动脉导管测得，此时测量的胸内血管压力可反映呼吸力学的变化，有助于检测PEEPi[10]。
3.7.2 PEEPi的管理
PEEPi可由呼气流量受限和较短的呼气时间造成。在对COPD患者进行机械通气时，应使用较小的潮气量、较低的呼吸频率和低吸呼比，以减少呼吸堆积，但这种情况可能会导致低每分钟通气量、高碳酸血症、缺氧、酸中毒、肺血管阻力增加，以及血流动力学不稳定等，可通过较高的吸气流量或合理的通气策略增加每分钟通气量，最终目的是达到适宜的pH值，而不是维持PaCO2在正常范围内。
对COPD患者使用PEEPe可在呼气末保持小气道开放，降低PEEPi，改善与呼吸机的相互作用，减少呼吸做功[40]。此外，PEEPe保持在PEEPi以下时，肺泡压力不会明显增加，也不会引发肺源性的心血管损害[10]。当PEEPe低于阈值时，有利于降低功能剩余容量和平台压[9]。PEEPe的应用也可消除患者的呼气气流受限，从而改善肺排空，减轻PEEPi。研究建议，PEEPe应接近80%~85%或等于可测得的PEEPi[10]。如果PEEPe明显高于PEEPi，额外的PEEPe不会改善呼吸功能，反而可能会导致肺泡过度扩张。因此，必须确定适当的PEEPe以避免额外的恶性膨胀[41]。
利用压力-容积曲线进行PEEPe滴定有助于估计理想的PEEPe。在相同肺容积下改变驱动压力并比较流量差异，有助于检测PEEPi。尽管驱动压力不同，但流量-容积曲线重叠(表示相同的呼气流量)意味着存在呼气气流受限，即PEEPi。在PEEPe递减的同时观察流量-容积曲线，当呼气流量提高时即可确定一个适宜的PEEPe[9]。理想的PEEPe位于压力-容积曲线下拐点之上，即促使塌陷肺泡开放的压力；如果PEEPe远高于下拐点，额外的PEEPe并不能改善呼吸功能，反而可能造成肺泡过度拉伸。因此，为避免肺损伤，PEEPe不应超过压力-容积曲线上拐点[12,42]。
EIT作为一种新的方法已被用于确定机械通气期间理想的PEEPe，可实时监测及量化肺通气变化。有研究在通过EIT确定PEEPe时发现，个体间PEEPe差异明显。与4 cmH2O的PEEPe相比，随机接受EIT监测策略的患者术后肺不张减轻、术中驱动压力降低、术中氧合增高，同时存在等效的血流动力学变化[43]。研究发现，在COPD急性加重期患者中，EIT测得的区域通气延迟可能有助于识别具有最适潮气量和最低气道阻力的PEEPe[44]，在滴定PEEPe的同时进行EIT监测，当发现塌陷和过度扩张达到最佳平衡时即可确定一个理想的PEEPe，而且可以连续监测、及时调整以避免VILI。
肺超声评估显示，使用PEEPe减少了机械通气期间的通气损失[45]；在PEEPe递增的同时行连续超声评估发现，递增法确定的PEEPe可使91.9%的患者肺不张减轻，超声图像评估逆转肺不张所需的平均PEEPe为17 cmH2O，防止肺泡塌陷的平均PEEPe为9 cmH2O[46]。目前尚缺乏肺超声应用于COPD患者指导个体化PEEPe的相关研究。
4 总结与展望
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COPD患者因呼气气流受限，肺呼吸力学发生改变，手术麻醉和机械通气时易影响肺部呼吸力学，从而导致患者预后不良。更好地理解COPD患者机械通气时的呼吸力学特点，有助于改善COPD患者的气体交换，如早期识别COPD患者机械通气时的空气潴留、DH、VH及PEEPi等呼吸力学特征，根据呼吸力学特征采取小潮气量、低呼吸频率、延长呼气时间、使用PEEPe等个体化的通气策略，有助于优化COPD患者的通气。在上述情况下，大多数现代呼吸机或麻醉机的通气图形(流量、压力和容积，CO2描记)以及新发展的EIT、OEP、肺超声等均有可能成为有价值的监测工具，协助临床机械通气时对COPD患者的呼吸力学变化及肺通气结果进行早期诊断与管理，值得临床进一步研究与应用。
基金
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  • 甘肃省卫生行业科研计划(GSWSKY2018-41)
文献
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2022年第47卷第12期
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doi: 10.11855/j.issn.0577-7402.2022.12.1262
  • 接收时间：2021-08-16
  • 首发时间：2025-12-14
  • 出版时间：2022-12-28
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  • 收稿日期：2021-08-16
  • 录用日期：2021-10-29
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Health Industry Research Project of Gansu Province(GSWSKY2018-41)
甘肃省卫生行业科研计划(GSWSKY2018-41)
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    兰州大学第二医院麻醉科，甘肃兰州 730030

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王迎斌，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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