The Changes Of Conductive Airways And Influence To Mechanical Ventilation In Chronic Obstructive Pulmonary Disease

Objective:To contrast the morphological changes of conductive airways and parameter of ventilator changes monitored by ventilator between acute exacerbation and after remission of respiratory failure in COPD patient. To the investigate reasons of airway obstruction and respiratory failure, it can provid us further evidence for direction therapeutic measures.Methods:After set up artificial airway and invasive mechanical ventilation in COPD with respiratory failure. To observe the bronchial wall and lumen and the mucosa of conductive airways in acute exacerbation stage and catabasis of COPD patient by using bronchofibroscope (external diameter of 4.5 mm), ultrathin bronchoscope (external diameter of 2.8 mm)and fibroptic angioscopy (external diameter of 1.8 mm) under direct vision, and record the monitoring indexes of breathing machine at the same time. To contrast morphology of airway and monitoring indexes with ventilator in COPD patient between acute exacerbation and after remission of respiratory failure.Results:The mucosal edema which was affected by hypoproteinemia and pulmonary heart disease(right heart insufficiency) was the main change in bronchial wall in the 48 cases in acute exacerbation of COPD. Some patients evoked intensive cough for stimulating in the examining of bronchofibroscope,we can find the gather together and obstruction in left and right main brochus and leafage segmental bronchus.Most happening in patients with hypoproteinemia and pneumocardial disease together.To compare the degree of hyperaemia and edema of central airway,there is significance beween acute exacerbation and after remission of respiratory failure in COPD patient (P<0.05).There is significance in the disappearance of cartilaginous ring (P<0.05).Hyperemia and edema still exist in peripheral airways and there was significant difference in mucosal ulcer,hemorrhage and severe stenosis compared with cases in acute exacerbation COPD (P<0.01).With regard to breathing mechanics indexes before pull out intubation and shut off breathing machine in the 41 cases with stable respiratory function,pulmonary compliance was increased;airway peak pressure,airway platform pressure,airway mean pressure and airway resistance in expiration and inspiration were decreased obviously (P<0.05)Conclusions:The main reason of airflow obstruction in acute exacerbation of COPD is reversible stegnosis happened in the base of inherent stegnosis.The pathogenetic condition is relieved due to the disengage of reversible stegnosis.The special characteristics of anatomy and blood circulation in conductive airway influenced the reversible stegnosis in COPD patients, especially to mucosal hyperaemia, edema, stegnosis and obstruction are inflenced by left and right heart function and hypoproteinemia, what follows next influenced airway resistence even bigger. When forced expiration or cough intensively in severe obstructive airway disease, increased thoracic pressure has an obviously influence to inner diameter of central airway and airtube could be enlightened. Through the examining of morphological changes of conductive airways by using bronchofibroscope, ultrathin bronchoscope and fibroptic angioscopy and the analysis of breathing mechanics indexes changes monitored by breathing machine,it is benefit for us to understand the reason of airway obstruction and respiratory failure.It can afford us more direction therapy to patients.