SIMV+AutoFlow对COPDⅡ型呼吸衰竭患者呼吸力学的影响  

The effect of SIMV+Autoflow on respiratory mechanics in COPD patients with type Ⅱ respiratory failure

作　　者：刘建锋 李维国 张军英 张玉清 王敏 朱桂军[2] 胡振杰[2] 

机构地区：[1]河北省故城县医院重症医学科,253800 [2]河北医科大学第四医院重症医学科

出　　处：《河北医药》2010年第17期2315-2317,共3页Hebei Medical Journal

摘　　要：目的观察慢性阻塞性肺疾病(COPD)Ⅱ型呼吸衰竭患者应用同步间歇指令通气辅用自动变流(SIMV+AutoFlow)模式时气道峰压(PIP)、平均压(Pmean)、阻力(R)、顺应性(C)和镇静剂使用量,评价SIMV+AutoFlow对呼吸力学的影响。方法选择需机械通气的COPDⅡ型呼衰患者59例,随机分为2组:Ⅰ组29例选用SIMV+AutoFlow模式,Ⅱ组30例选用SIMV模式,观察2种模式下患者PIP、Pmean、R、C和镇静剂使用量。结果Ⅰ组在上机后2、24、48h的PIP、Pmean、R及上机72h镇静剂的使用量显著低于Ⅱ组(P<0.05);C显著高于Ⅱ组(P<0.05);2组患者一般情况、上机前后的血气指标和APACHEⅡ评分差异无统计学意义(P>0.05)。结论 COPDⅡ型呼吸衰竭患者应用SIMV+AutoFlow通气模式,能显著降低PIP、Pmean、R,改善呼吸力学,在需要保证输送潮气量,又尽量减少机械通气并发症时,采用SIMV+AutoFlow是一种较好的方法 。Objective To compare the effect of SIMV and SIMV with Autoflow on peak pressuer,mean airway pressure,airway resistance,compliance in COPD patients with type Ⅱ respiratory failure.Methods 59 COPD patients with type Ⅱ respiratory failure,who needed mechanical ventilation,were randomly divided into two groups,the 29 patients in groupⅠwere treated by SIMV ＋AutoFlow,however,the other 30 patients in group Ⅱ were treated by SIMV.The PIP,PmeanR,C and the dosage of tranquilizer were observed for both groups.Results The PIP,Pmean,R at 2h,24h,48h after mechanical ventilation and the dosage of tranquilizer after 72h in group Ⅰ were significantly lower than those of group Ⅱ（P0.05）,however,the C in in groupⅠwas significantly higher than that of group Ⅱ（P0.05）.There were no significant differences in patients’ symptoms,blood gas parameters,APACHE II score before and after mechanical ventilation between the two groups （P0.05）.Conclusion The SIMV ＋AutoFlow can reduce peak airway pressure,mean airway pressure,resistance,and can improve obviously respiratory mechanics,so SIMV ＋AutoFlow is a better way in assuring sufficient tidal volume and reducing complication of mechanical ventilation in COPD patients with type Ⅱ respiratory failure.

关 键 词：机械通气 自动变流 呼吸力学 慢性阻塞性肺疾病 Ⅱ型呼吸衰竭 动脉血气 

分 类 号：R563[医药卫生—呼吸系统]