无创智能模式平均容量保证压力支持在AECOPD伴Ⅱ型呼吸衰竭中的治疗作用  

Therapeutic effect of non-invasive intelligent model(average volume assured pressure support)on patients with acute exacerbation of chronic obstructive pulmonary disease combined with typeⅡrespiratory failure

作　　者：蒋萍[1] 杨春梅 Jiang Ping;Yang Chunmei(Department of Respiratory Disease,the Second People′s Hospital of Chengdu,Chengdu 610010,China)

机构地区：[1]成都市第二人民医院呼吸科,610010

出　　处：《国际呼吸杂志》2019年第24期1858-1862,共5页International Journal of Respiration

摘　　要：目的结合分钟通气量(VE)等呼吸机参数,与传统自主呼吸时间保证模式(S-T)相比较,了解平均容量保证压力支持模式(AVAPS)对伴高碳酸血症呼吸衰竭的慢性阻塞性肺病急性加重(AECOPD)患者的治疗作用。方法伴Ⅱ型呼吸衰竭和意识障碍的AECOPD患者54例,随机分组后分别接受无创呼吸机AVAPS模式(27例)及S-T模式(27例)治疗,观察2组治疗前和治疗2、4、12、24 h后的动脉血气值、格拉斯哥(GCS)评分及VE等呼吸机参数。结果2组患者在无创呼吸机治疗后pH值、PCO2、GCS评分均改善(P值均<0.05)。在治疗2、4 h时,2组PCO2差异无统计学意义;在12、24 h时,AVAPS组PCO2低于S-T组(P值均<0.05)。在治疗24 h时,AVAPS组pH值高于S-T组(P<0.05)。在各时间段,2组GCS评分差异无统计学意义。在治疗前和治疗2、4、12 h时,2组VE差异无统计学意义;在治疗24 h时,AVAPS组VE高于S-T组(P<0.05)。在观察期间,AVAPS组患者治疗过程中VE的变异度更小,更稳定。2组插管率差异无统计学意义。结论对伴Ⅱ型呼吸衰竭的AECOPD患者,AVAPS模式治疗改善二氧化碳潴留效果优于S-T模式,其优势体现在实际VE达到预设值并持续稳定。Objective To study the clinical efficacy of average volume assured pressure support(AVAPS)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with hypercapnic respiratory failure through comparing with traditional spontaneous breathing and time control(S-T)model by ventilator parameters such as minute ventilation volume(VE).Methods According to randomization,54 patients with AECOPD with typeⅡrespiratory failure and disturbance of consciousness accepted noninvasive ventilator treatment,AVAPS model(n=27)or S-T model(n=27).The ventilator parameters such as blood gas,Glasgow coma scale(GCS),and VE were measured before the treatment and after the treatment for 2,4,12,24 hours.Results After non-invasive ventilator treatment,pH,PCO2,GCS score of the patients in the two groups improved significantly(all P<0.05).After treatment for 2,4 hours,there was no statistical difference in PCO2 between the two groups,but PCO2 in AVAPS group was lower than that in S-T group after treatment for 12,24 hours(all P<0.05).After treatment for 24 hours,pH in AVAPS group was higher than that in S-T group(P<0.05).In each time period,there was no statistical difference in GCS score between the two groups.Before the treatment and after the treatment for 2,4,12 hours,there was no statistical difference in VE between the two groups,but VE in AVAPS group was higher than that in S-T group after the treatment for 24 hours(P<0.05).During the observation,the variability of VE in AVAPS group was smaller and more stable.There was no significant difference in the intubation rate between the two groups.Conclusions For patients with AECOPD combined with typeⅡrespiratory failure,the effect of AVAPS model on improving carbon dioxide retention is better than that of S-T model,the advantage of which is that the actual VE value is expected and consistently stable.

关 键 词：呼吸功能不全 格拉斯哥评分 平均容量保证压力支持 分钟通气量 

分 类 号：R56[医药卫生—呼吸系统]