呼吸机波形监测对AECOPD患者无创通气的意义  

The role of ventilator waveform monitoring in the treatment of AECOPD by noninvasive ventilation

作　　者：徐进步[1] 汪允珍[1] 施青山[1] 曹莉锋[1] 

机构地区：[1]连云港市第二人民医院重症医学科,江苏连云港222000

出　　处：《徐州医学院学报》2013年第4期246-249,共4页Acta Academiae Medicinae Xuzhou

摘　　要：目的探讨通过呼吸机波形监测改善人机协调性对改善慢性阻塞性肺疾病急性加重（acute exarceba—tion of chronic obstructed pulmonary disease，AECOPD）患者无创通气疗效的作用。方法65例需无创通气的AE—COPD患者，随机分为处理组和对照组。2组患者均给予无创通气及常规药物治疗。对照组在无创通气时仅按规范设置呼吸机参数；处理组在此基础上通过监测呼吸机波形调节呼吸机设置，改善人机协调性。观察2组患者在血气分析、呼吸频率、呼吸机耐受程度、无创通气时间及插管率方面的差异。结果处理组患者二氧化碳分压（PaCO2）与pH改善速度显著快于对照组，治疗后2～6h呼吸机耐受程度好于对照组，无创通气时间显著缩短（P〈0．05）；2组患者呼吸频率与氧合指数（PaO2／FiO2）改善程度无统计学差异，插管率无统计学差异（P〉0．05）。结论通过监测呼吸机波形来改善人机协调性，可以使无创通气AECOPD患者尽早改善阻塞性通气状态，更好地耐受无创通气，并缩短无刨通气时间。Objective To investigate the effect of enhancing human - machine synchrony through monitoring venti-lator waveforms during noninvasive ventilation in the treatment of acute exarcebation of chronic obstructed pulmonary dis-ease （AECOPD）. Methods 65 patients, diagnosed as AECOPD, were randomly assigned into treatment group and con- trol group. Both groups were treated with noninvasive ventilation and routine drug trerapy. The ventilator settings of the control group were only decided according to guideline, while in the treatment group, the ventilator waveforms were ob-served. According to which we made adjustment to the ventilator setting to enhance human-machine synchrony. The outcome taken into account included the blood gas anlysis, respitatory rate （RR）, ventilation time, and intubation rate. They were compared between the two groups. Results In comparison to the control group, the treatment group witnessed significantly quicker improvements in PaCO2 , pH, better tolerance to ventilator, shorter duration of ventilation time （ P 〈 0.05 ） , but with no remarkable further improvements in RR and oxygenation index （ PaO2/FiO2 ）. The intubation rate was also not significantly different between the two groups （ P 〉 0.05 ）. Conclusion The study of ventilation waves to enhance human - machine synchrony would lead to earlier relief of obstruction in respiration, better tolerance ventilator, and shorter ventilation time.

关 键 词：慢性阻塞性肺疾病急性加重 无创通气 人机协调性 呼吸机波形 

分 类 号：R562[医药卫生—呼吸系统]