慢性阻塞性肺疾病机械通气患者两种不同通气模式的比较  

Comparison of two different ventilation modes in mechanical ventilation patients with chronic obstructive pulmonary disease

作　　者：阎锡新[1] 高耐芬[2] 刘菲菲[1] 石玉珍[1] 

机构地区：[1]河北医科大学第二医院呼吸内科,河北石家庄050000 [2]石家庄市第二医院呼吸内科,河北石家庄050051

出　　处：《临床荟萃》2009年第2期102-105,共4页Clinical Focus

摘　　要：目的探讨适应性支持通气(ASV)在慢性阻塞性肺疾病(COPD)机械通气患者中的应用。方法24例存在自主呼吸行机械通气的COPD患者随机分成两组,一组先使用辅助/控制通气(A/C)模式后改为ASV模式,另一组先使用A/C模式后改为同步间歇指令通气联合压力支持通气(SIMV+PSV)模式,采用对照性研究方法,比较前后两种通气模式对患者的呼吸力学、血流动力学和血气分析的影响,以及两组间的有创通气时间、机械通气总时间、撤机成功率及调机次数。结果从A/C模式改为ASV后患者的呼吸频率(RR)、气道峰压(Pp)、平均气道压(Pm)、气道闭合压(P0.1)和浅快呼吸指数(RSB)下降,潮气量(VT)和肺顺应性(C)上升(P<0.01);从A/C模式改为SIMV+PSV后RR、Pp、Pm、P0.1和RSB下降(P<0.01)。两组其余呼吸力学、血流动力学及血气分析指标变更模式前后差异均无统计学意义,两组之间的有创通气时间、机械通气总时间、撤机成功率差异无统计学意义,但是ASV组的调机次数明显少于SIMV+PSV组(8.5±2.2 vs 13.1±3.1,P<0.01)。结论ASV和SIMV+PSV与A/C比较能在一定程度上降低呼吸负荷,保护肺组织。运用于撤机时两种模式效果无明显差别,但ASV操作相对简单,适合于临床医师使用。Objective To investigate the effects of adaptive support ventilation（ASV） on mechanical ventilation patients with chronic obstructive pulmonary disease（COPD）. Methods Twenty-four mechanical ventilation patients with COPD were randomly divided into two groups,and they all had spontaneously breathing,the A/C mode was used in the initial stage, then the mode was changed into ASV or synchronized intermittent mandatory ventilation plus inspiratory pressure support （SIMV ＋ PSV） mode. Comparing the change of the patients, breathing mechanics, haemodynamics and blood gas analysis when the mode was changed,and comparing the regulation rate during SIMV＋ PSV or ASV stage. duration of invasion ventilation, duration of non-invasion ventilation and achievement ratio of extubation. Results With regard to ASV group,the respiratory rate（RR） ,peak airway pressure（Ppeak）,mean airway pressure（Pmean）, airway occlusion pressure（P0.1 ）, and rapid shallow breathing index（RSB） descended, but tidal volume （VT） and static compliance（C） heightened（ P 〈0.01）. With regard to SIMV＋ PSV group, the RR, Ppeak, Pmean, P0.1 and RSB descended（ P 〈0.01）. But the changes of other indexes of breathing mechanics, haemodynamics and blood gas analysis were not statistically significant. The duration of invasion ventilation, duration of non-invasion ventilation and achievement ratio of extubation between two groups were not statistically significant,but the regulation rate during using ASV as fewer （8.5 ± 2.2 vs 13.1±3.1, P〈0.01）. Conclusion Compared with conventional ventilation mode （A/C） ,the ASV and SIMV＋PSV all can lessen the breathing loading and protect patients lung. The two modes are all reasonable for extubating,but the operating of ASV is simpler and easier to be mastered by clinicians.

关 键 词：肺疾病 慢性阻塞性 呼吸 人工 呼吸力学 对比研究 

分 类 号：R563[医药卫生—呼吸系统]