急性呼吸窘迫综合征患者适应性支持通气的效果  

Effect of adaptive support ventilation in patients with ARDS

作　　者：秦宗和[1] 方玉明[1] 应佑国[1] 

机构地区：[1]上海交通大学医学院第三人民医院ICU,201900

出　　处：《中华麻醉学杂志》2006年第11期994-996,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价适应性支持通气(ASV)模式与间歇正压通气(IPPV)模式在急性呼吸窘迫综合征(ARDS)患者中的效果。方法ARDS患者30例,年龄19-46岁,男18例,女12例,ASAⅢ或Ⅳ级。先应用IPPV模式,吸入氧浓度60％,PEEP为0,潮气量(VT)10ml／kg,吸呼比(I:E)1:2,维持8 h后随机选择换用ASV或继续IPPV通气模式,通气时依次按0、5、10 cm H2O增加PEEP,每一PEEP水平的通气时间为60 min,在同样的分钟通气量的设置下,4 h后更换另一种通气模式,仍按0、5、10 cm H2O增加PEEP,每一PEEP水平的通气时间为60 min。每个PEEP水平通气50 min时,用Swan-Ganz导管、心电监测仪、呼吸机监测记录血液动力学、呼吸力学和氧代谢数据。结果与IPPV模式比较,ASV模式下气道峰值压降低,肺动态顺应性(Cdyn)、动脉氧分压(PaO2)和氧供(DO2)增加(P<0．05)。两种通气模式的血液动力学参数比较差异无统计学意义(P>0．05)。结论ASV模式比IPPV模式更有利于ARDS患者的通气治疗。Objective To investigate the effects of adaptive support ventilation （ASV） on respiratory mechanics, hemodynamics and oxygen delivery in patients with acute respiratory distress syndrome （ARDS）. Methods Thirty patients with ARDS （18 males, 12 females） aged 19-46 yrs were mechanically ventilated by 2 modes, IPPV and ASV with 3 levels of PEEP （0, 5, 10 cm H2O）. Each level of PEEP was maintained for 60 min. Every patient was initially ventilated with IPPV or ASV for 4 h. Then the two modes of ventilation alternated with each other and the patient was ventilated for another 4 hours. Swan-Ganz catheter was placed in internal jugular vein. Respiratory mechanics, hemodynamics and oxygen delivery and consumption were measured, calculated and recorded after the patients were ventilated with each level of PEEP for 50 min. Results Peak inspiratory pressure （PIP） was significantly lower and dynamic lung compliance （Cdyn）, PaO2 and oxygen delivery （DO2） were significantly higher during ASV than during IPPV in the same patient. There was no significant difference in MAP, pulmonary arterial pressure （PAP）, cardiac index （CI）, SVRI and PVRI during ventilation with IPPV and ASV. Conclusion ASV can decrease PIP and increase Cdyn and DO2 as compared with IPPV in patients with ARDS.

关 键 词：呼吸窘迫综合征 成人 间歇正压通气 适应性支持通气 

分 类 号：R563.8[医药卫生—呼吸系统]