适应性支持通气与传统指令通气治疗小儿呼吸衰竭的比较研究  

Comparison of adaptive support ventilation and conventional mandatory ventilation in treatment of pediatric acute respiratory failure

作　　者：田庆玲[1] 陆铸今[2] 陆国平[2] 贡海蓉[2] 陈伟明[2] 卢亚芳[2] 

机构地区：[1]复旦大学附属儿科医院急救科进修医生,上海200032 [2]复旦大学附属儿科医院急救科

出　　处：《中国小儿急救医学》2007年第3期215-217,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的比较适应性支持通气（ASV）与传统指令通气（CMV）对呼吸衰竭患儿通气参数和人机对抗的影响。方法采用自身对照方法对复旦大学儿科医院PICU2006年3～8月20例呼吸衰竭患儿先予CMV模式机械通气，45min后改ASV模式。记录两种模式下的通气参数、血气分析和平均动脉压等指标的变化。结果ASV模式下吸气峰压、平均气道压、控制频率、浅快呼吸指数分别较CMV模式明显下降（P〈0．01、P〈0．05、P〈0．01和P〈0．05）。两种模式间的总呼吸频率、潮气量、分钟通气量、呼吸顺应性差异无显著性（P值均〉0．05），动脉血氧分压、动脉血二氧化碳分压及平均动脉压差异亦无显著性（P值均2〉0．05）。结论ASV较常规通气模式有利于减轻气压伤、减少人机对抗、实行肺保护策略。Objective To compare the ventilator settings and changes of respiratory mechanics between adaptive support ventilation （ASV） and conventional mandatory ventilation （CMV） in treatment of pediatric acute respiratory failure, Methods From March 2006 to August 2006, 20 cases of pediatric respiratory failure in PICU were collected for study. They were initially ventilated with CMV （45 minutes）and then shifted to ASV. The respiratory monitoring parameters, arterial blood gases, and mean arterial blood pressure （MAP） were recorded 45 minutes after the beginning of CMV and ASV respectively. Results The levels of peak airway pressure （Ppeak）, mean airway pressure （Pmean）, machinery-controlled frequency （fe）, rapidshallow breathing index （RSB） in ASV mode were greatly decreased than those in CMV （ P 〈 0.01, P 〈 0.05, P 〈 0.01, P 〈 0.05）, There were no significant differences in values of total breathing frequency （ft）, tidal volume （Vt）, minute ventilation （MV）, static compliance （Cst）, arterial oxygen tension （ PaO2 ）, arterial carbon dioxide tension （PaCO2） and MAP between ASV and CMV mode（ P 2〉 0.05）. Conclusion ASV can decrease the airway pressure and improve patient-ventilator compatibility, which is beneficial for the strategy of lung protection.

关 键 词：适应性支持通气 传统指令通气 呼吸衰竭 儿童 

分 类 号：R72[医药卫生—儿科]