比较不同通气模式下治疗慢性阻塞性肺病急性加重合并呼吸衰竭的临床疗效  

The Clinical Efficacy of Treating Chronic Obstructive Pulmonary Disease in Patients with Chronic Obstructive Pulmonary Disease Was Analyzed with Different Ventilation Modes

作　　者：周里 王岩[1] 

机构地区：[1]哈尔滨二四二医院,黑龙江哈尔滨150066

出　　处：《航空航天医学杂志》2018年第1期1-6,共6页Journal of Aerospace medicine

摘　　要：目的观察比较不同通气模式下治疗慢性阻塞性肺病急性加重合并呼吸衰竭的临床疗效,为临床治疗提供参考依据。方法收集我院重症医学科2013年7月至2016年7月间收治的慢性阻塞性肺病急性加重期合并呼吸衰竭30例患者作为研究对象,根据机械通气模式分为两组:同步间歇指令通气(SIMV)+压力支持通气(PSV)组和适应性压力支持通气(ASV)组,每组各15例。比较两组患者治疗前及治疗后生命体征、外周血循环参数及血气分析指标(HR、RR、MAP、CVP、PH、PaO_2、PaCO_2、PaO_2/FiO_2、P(A-a)O_2);比较两组模式呼吸机相关参数及对呼吸动力学的影响(MV、TV、PIF、Ppeak、Pplat、Pmean、I/E);比较两组患者在治疗前及治疗后肺功能指标水平的变化(FEV_1、FVC、PEFR);比较两组模式下有创机械时间及ICU治疗时间。结果两组患者治疗前各项生命体征、外周血管循环参数及血气分析指标比较差异无统计学意义(P>0.05),治疗后两组患者心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、中心静脉压(CVP)、二氧化碳分压(PaCO_2)、肺泡—动脉氧分压差[P(A-a)O_2]低于治疗前,pH值、氧分压(PaO_2),氧合指数(PaO_2/FiO_2)高于治疗前,差异有统计学意义(P<0.05)。比较治疗后ASV模式组患者潮气量(TV)、吸气峰流量(PIF)高于SIMV+PSV模式组,差异有统计学意义(P<0.05),ASV模式组患者每分通气量(MV)、气道峰压(Ppeak)、气道平台压(Pplat)、平均气道压(Pmean)、呼吸比(I/E)低于SIMV+PSV模式组,差异有统计学意义(P<0.05)。两组患者治疗前肺功能各项指标水平比较差异无统计学意义(P>0.05),治疗后ASV模式组肺功能各项指标水平1S用力呼吸容量(FEV1)、用力肺活量(FVC)、最大呼气流速(PEFR)均高于SIMV+PSV模式组,差异有统计学意义(P<0.05)。比较AVS模式组机械通气时间及ICU治疗时间低于SIMV+PSV模式组,差异有统计学意义(P<0.05)。结论 SIMV+PSV模式与ASV模式均为治疗COPD�Objective To observe the clinical effect of treatment of chronic obstructive pulmonary disease in patients with chronic obstructive pulmonary disease with different ventilation modes,and to provide a reference basis for clinical treatment. Methods To collect data intensive medicine in July 2013 to July 2016 were chronic obstructive pulmonary disease of the 30 cases of acute aggravating combination of respiratory failure patients as the research object,according to the mechanical ventilation mode is divided into two groups： synchronous intermittent ventilation（SIMV） instruction ＋pressure support ventilation（PSV） and adaptive pressure support ventilation（ASV） groups,each group（n = 15）. To compare the life signs,peripheral blood circulation and blood gas analysis indexes before and after treatment of two groups of patients（HR、RR、MAP、CVP、PH、PaO_2、PaCO_2、PaO_2/FiO_2、P（A-a）O_2）; Compare the relative parameters of the two sets of model ventilator and its effect on respiratory dynamics（MV、TV、PIF、Ppeak、Pplat、Pmean、I/E）; To compare the changes in the level of lung function before and after treatment of two groups of patients（FEV1、FVC、PEFR）; In comparison with the two sets of models,there was a time of mechanical time and ICU treatment. Results The two groups of patients before treatment the vital signs,peripheral vascular circulation parameters and blood gas analysis index comparison difference was no statistical significance（P〈0. 05）,the two groups after treatment in patients with heart rate（HR）,respiratory rate（RR）,mean arterial pressure（MAP）,central venous pressure（CVP）,partial pressure of carbon dioxide（PaCO_2）,alveolar-arterial oxygen partial pressure difference [P（A-a）O_2]is lower than before the treatment,potential of hydrogen,oxygen partial pressure（PaO_2）,oxygenation index（PaO_2/FiO_2） is higher than before the treatment,the difference was statistically significant（P〈0. 05）. ASV model group after treatme

关 键 词：慢性阻塞性肺病 呼吸衰竭 机械通气 同步间歇指令通气 压力支持通气 适应性压力支持通气 

分 类 号：R563.8[医药卫生—呼吸系统]