- 期刊
COPD合併hyperinflation氣切個案應用發聲閥與噘嘴呼吸於呼吸器
Experience of COPD combined with hyperinflation, using a speaking valve and pursed-lip breathing during weaning from mechanical ventilator
摘要
慢性阻塞性肺疾病是一種因為慢性呼吸道發炎造成呼吸道阻塞的疾病，疾病的進展緩慢，大多數患者都是中老年出現了咳、痰、喘症狀後就醫才被診斷，此個案為78歲男性，於2017年肺功能已呈現中度肺阻塞，此次因肺炎導致呼吸衰竭插管並接受氣切手術後，仍面臨呼吸器脫離困難，此個案嘗試以發聲閥（speaking valve）進行呼吸器脫離，並測量病患的經氣管壓（transtracheal pressure）評估吐氣壓及電阻抗斷層成像（electrical impedance tomography, EIT）來偵測肺部的氣體分佈狀態後，應證了speaking valve產生的吐氣末正壓及配合病人使用噘嘴式呼吸而產生背壓，可以克服小氣道阻塞與改善通氣，最後個案順利於日間完全脫離呼吸器，同時也提升了生活品質，在此慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）合併肺過度充氣（hyperinflation）的個案，應用發聲閥與噘嘴呼吸於呼吸器脫離的經驗中，讓我們有了不同的思維也在本篇文章做進一步的探討。
並列摘要
Chronic obstructive pulmonary disease (COPD) is a disease of airway obstruction caused by chronic inflammation of the airways. The disease progresses slowly and most patients are diagnosed in middle age and old age after developing symptoms of cough, sputum and wheezing. This case is a 78-year-old male who presented with moderate pulmonary obstruction in 2017. This time he was intubated for respiratory failure due to pneumonia and remained difficult to wean from the ventilator after tracheostomy operation. An attempt was made to connect a unidirectional valve to the tracheostomy tube to simulate a speaking valve. Measuring the patient's transtracheal pressure and monitoring the dynamic changes in lung function with EIT confirmed that the positive end-expiratory pressure caused by the speaking valve and the back pressure generated by the patient's pursed-lip breathing allowed the patient to overcome hyperventilation and small airway obstruction achieve complete daytime weaning from the ventilator, further improving the quality of life. This experience of ventilator weaning has led us to think differently about ventilator weaning in patients with COPD combined with hyperventilation.
延伸閱讀
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