适应性支持通气在老年急性呼吸窘迫综合征中的应用  

Application of adaptive support ventilation in elderly patients with acute respiratory distress syndrome

作　　者：卞叶萍[1] 顾永辉[1] 邓晓静[1] 程惠[1] 徐剑[1] 佘丽萍 BIAN Ye-ping, GU Yong-hui, DENG Xiao-jing, CHENG Hui, XU Jian, SHE Li-ping.(Department of Intensive Care Unit, Jiangsu Province Official Hospital, Nanjing 210024, Chin)

机构地区：[1]江苏省省级机关医院重症监护室,江苏省南京市210024

出　　处：《实用老年医学》2018年第3期237-240,共4页Practical Geriatrics

基　　金：江苏省老年医学研究所科研项目(LK201302)

摘　　要：目的探讨适应性支持通气(adaptive support ventilation,ASV)在老年急性呼吸窘迫综合征病人中的临床应用价值。方法入组2013年1月至2016年6月入住江苏省省级机关医院重症监护病房的年龄≥65岁的急性呼吸窘迫综合征行有创机械通气的病人32例,将ASV模式与同步间歇指令通气模式(SIMV)进行前后自身比较,探讨ASV模式对呼吸力学、血流动力学、血气指标及舒适度的影响。结果两种模式下病人动脉血氧合指数、二氧化碳分压、乳酸水平比较差异无统计学意义(P>0.05),分钟通气量、胸肺动态顺应性、潮气量差异亦无统计学意义(P>0.05),但在ASV模式下病人气道峰压、平均气道压力、吸气阻力及呼吸频率明显低于SIMV模式(P<0.05),重症监护室疼痛观察工具法(CPOT)评分、躁动镇静评估表(RASS)评分、丙泊酚使用剂量亦降低(P<0.05),ASV通气模式下地佐辛及咪达唑仑使用剂量较SIMV模式有下降趋势,但差异无统计学意义(P>0.05)。结论 ASV模式可改善老年急性呼吸窘迫综合征病人呼吸力学指标,增加舒适度,安全有效。Objective To explore the clinical application of adaptive support ventilation（ ASV） in elderly patients with acute respiratory distress syndrome（ ARDS）.Methods Thirty-two patients（ ≥65 years old） with ARDS admitted in the intensive care unit of Jiangsu Province official Hospital from January 2013 to June 2016 were enrolled.At ASV mode or synchronized intermittent mandatory ventilation mode（ SIMV）,the respiratory mechanics,hemodynamics,oxygen dynamics and comfort were detected and compared.Results The difference in arterial PaO_2/FiO_2,carbon dioxide pressure,lactate,heart rate,mean arterial pressure,central venous pressure,minute ventilation,chest and lung dynamic compliance and tidal volume between the two modes was not statistically significant（ P 〉0.05）.Under the ASV mode,the peak airway pressure（ 33.66 ± 3.06 mm Hg）,the mean airway pressure（ 24.69±2.68 mm Hg）,the inspiratory resistance [12.63±2.38 cm H_2O/（ L·s） ],CPOT score（ 1.13±0.75）,RASS score[0.5（-1,1） ],propofol dose（ 78.84±34.98 mg） and respiratory rate（ 20.65±3.71 times/min）,were significantly lower than those under SIMV mode（ P〈0.05）.Conclusions Compared with the SIMV mode,the ASV mode can improve the respiratory mechanics index and can increase the comfort degree of the elderly patients with ARDS safely and effectively.

关 键 词：急性呼吸窘迫综合征 老年人 适应性支持通气 同步间歇指令通气 呼吸力学 舒适度 

分 类 号：R563.8[医药卫生—呼吸系统]