适应性支持通气在COPD合并肺栓塞老年患者中的临床效果与护理体会  

Effect of adaptive support ventilation on elderly patients with COPD complicated with pulmonary thromboembo-lism

作　　者：王月霞[1] 张罗献[1] 刘豹[1] 忽新刚[1] 

机构地区：[1]河南省人民医院呼吸与危重症医学科,郑州450003

出　　处：《中国实用医刊》2015年第16期69-71,共3页Chinese Journal of Practical Medicine

摘　　要：目的：探讨适应性支持通气在慢性阻塞性肺疾病（COPD）合并肺栓塞老年患者中应用效果观察及护理体会。方法选择 COPD 合并肺栓塞老年患者56例，将其随机分为两组，每组28例，在综合治疗的基础上，治疗组患者接受适应性支持通气，对照组压力支持同步间歇指令通气＋呼气末正压，比较两组患者机械通气治疗过程中，呼吸力学和临床护理监测指标变化。护理特点：应用呼吸机辅助通气前对患者做好心理护理，同期过程中注意患者的一般情况及呼吸机监控数据变化，注意人工气道护理。对于抗凝或溶栓患者，注意此类药物的监测疗效及不良反应。协助完成各项出凝血指标的测定。结果与对照组比较，治疗组患者呼吸力学参数明显改善。结论适应性支持通气，结合综合护理措施可提高患者潮气量，降低呼吸频率，呼吸肌做功减少，改善人机协调性。Objective To investigate the clinical value of the adaptive support ventilation（ASV）in elderly patients with chronic obstructive pulmonary disease（COPD）complicated with pulmonary thromboembolism. Methods Fifty-six cases of COPD complicated with pulmonary thromboembolism and respiratory failure needed mechanical ventilation were randomly divided into two groups with 28 cases in each group. The treated group was assigned to adaptive support ventila-tion,while the other 28 cases of the control group were assigned to pressure support synchronized mandatory ventilalion exhaust ventilation plus positive endexpiratory pressure（P-SIMV ＋ PEEP）support. Both groups were all ventilated until weaning,respiratory mechanics indicators were compared between the two groups. Results Compared with the control group, there was significantly reduced respiratory frequency,increased tidal volume（VT）,declined plateau pressure（Pplat）, peak airway pressure（Ppeak）and inspiratory resistance（R）,increased static compliance（Cstat）. Reduced WOBimp and PTP,and shorter duration of mechanical ventilation（all P ﹤ 0. 05）. Conclusions Compared with P-SIMV mode,ASV support can enhance spontaneous tidal volume,reduce respiratory rate and respiratory muscle work,increase man-machine harmonization,and shorten the duration of mechanical ventilation.

关 键 词：适应性支持通气 慢性阻塞性肺疾病 肺栓塞 护理 

分 类 号：R459.6[医药卫生—治疗学]