BiP AP+AVPAS通气模式在老年AECOPD病人中的应用研究  

Application of BiP AP+AVAPS ventilation modes in elderly patients with AECOPD

作　　者：鲍磊[1] 秦海东[1] 肖峰[1] 季伟[1] 宋杨[1] 刘晓东[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)急诊医学科,江苏省南京市210006

出　　处：《实用老年医学》2017年第9期826-829,共4页Practical Geriatrics

摘　　要：目的研究双水平正压通气(Bi PAP)+平均容量保证压力支持通气(AVPAS)模式联合无创经皮监测(transcutaneous monitoring,TCM)在老年慢性阻塞性肺疾病急性加重(AECOPD)病人中的应用。方法将本院2015年12月至2016年6月急诊病房收治的30例老年AECOPD病人随机分为Bi PAP+自主触发/时间(S/T)组(S/T组)和Bi PAP+AVPAS组(AVPAS组),每组15例。所有病人在无创通气治疗前、通气1 h后监测呼吸频率(RR)、心率(HR)、收缩压(SBP)、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、经皮二氧化碳分压(PtcCO2)、经皮氧分压(PtcO_2),评估APACHEⅡ评分并比较。结果 PtcCO_2和PaCO_2(r=0.958,P<0.01)、PtcO_2和PaO_2(r=0.925,P<0.01)呈正相关。治疗前2组间上述观察指标差异均无统计学意义(P>0.05)。与治疗前相比,2组治疗后HR、RR、SBP、PtcCO_2、APACHEⅡ评分均下降(P<0.05),PtcO_2升高(P<0.05)。治疗后与S/T组相比,AVPAS组PtcCO_2下降更明显(P<0.05),PtcO_2升高更显著(P<0.05),APACHEⅡ评分改善更显著(P<0.05)。结论在老年AECOPD病人的治疗中,予以Bi PAP+AVAPS通气模式联合TCM监测,能提供更为准确、及时、有效的治疗。Objective To investigate the effect of Bi PAP ＋AVAPS ventilation modes combined with transculaneous monitoring（ TCM） in elderly patients with acute exacerbation chronic obstructive pulmonary disease（ AECOPD）. Methods Thirty patients with AECOPD were randomly divided into Bi PAP ＋S/T group（ S/T group） and Bi PAP ＋AVPAS group（ AVPAS group）,with 15 cases in each group.All patients were evaluated for respiratory rate（ RR）,heart rate（ HR）,systolic blood pressure（ SBP）,arterial carbon dioxide partial pressure（ PaCO_2）,arterial oxygen pressure（ PaO_2）,transcutaneous partial pressure of carbon dioxide（ PtcCO_2）,and percutaneous oxygen partial pressure（ PtcO_2） before and after 1 h of spontaneous ventilation and APACHE Ⅱ score was evaluated. Results The level of PtcCO_2 was positively correlated with PaCO_2（ r= 0. 958,P〈0. 01）,and the level of PtcO_2 was positively correlated with PaO_2（ r= 0. 925,P 0. 01）. There was no significant difference in RR,HR,SBP,PaCO_2,PaO_2,PtcCO_2 and PtcO_2 between the two groups before treatment（ P〈0. 05）. The levels of HR,RR,SBP,PtcCO_2,APACHEⅡ score in two groups were decreased（ P〈0. 05）,and PtcO_2increased（ P〈0. 05） after treatment. Compared with S/T group,the level of PtcCO_2 in AVPAS group decreased more significantly（ P〈0. 05）,PtcO_2 increased significantly（ P〈0. 05）,and APACHEⅡ score improved significantly（ P〈0. 05） after treatment. Conclusions In the elderly patients with AECOPD,Bi PAP ＋AVAPS ventilation modes combined with TCM, can provide more accurate, timely and effective treatment.

关 键 词：慢性阻塞性肺疾病急性加重期 BiPAP+S/T BiPAP+AVPAS 无创经皮监测 经皮氧分压 经皮二氧化碳分压 

分 类 号：R563[医药卫生—呼吸系统]