带有负载可调增益因子比例辅助通气模式的研究进展  

Research progress of proportional assisted ventilation with load-adjustable gain factors

作　　者：罗茜[1] 李振源 毛淑贞 罗杰英[1] 樊麦英[1] 文辉[1] 韩小彤[1] Luo Qian;Li Zhenyuan;Mao Shuzhen;Luo Jieying;Fan Maiying;Wen Hui;Han Xiaotong(Department of Emergency Medicine,the First Affiliated Hospital of Hunan Normal University,Hunan Provincial People's Hospital,Changsha 410005,Hunan,China)

机构地区：[1]湖南师范大学附属第一医院/湖南省人民医院急诊医学科,长沙410005

出　　处：《中国中西医结合急救杂志》2022年第1期107-110,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：2020年湖南省重大专项(2020SK1011);2016年仁术基金(RS201625)。

摘　　要：在严重呼吸衰竭情况下,控制性机械通气可能是必不可少的,但会对患者产生一些不良影响,因此,应尽可能地尽早切换为辅助通气.带有负载可调增益因子比例辅助通气(PAV+)为一种新兴的辅助通气模式,它是一种不需要设置目标潮气量、流量或压力,呼吸机提供的压力与患者的瞬时吸气努力成比例,让患者能舒适地达到自身的通气需求,患者吸气流速停止,呼吸机将停止送气,吸气结束的通气模式.理想的患者-呼吸机互动意味着患者的吸气周期的开始和结束都能被正确地检测到,并且与呼吸机提供的辅助是同步的,与患者的需求和努力成比例.PAV+的生理优势就是如此,由于其工作原理,PAV+能够提供自我调节的肺和膈肌的保护性通气,这也是目前机械通气的治疗目的.研究表明,与常规模式相比,PAV+应用简单、省时、经济,在危重患者中可以更有效地减少人机不同步,以及改善呼吸机支持以适应不断变化的患者需求,促进脱机,改善睡眠质量、氧合、心脏指数等.在临床应用上,PAV+能自动监测平台压和自动调整驱动压,在有自主呼吸的患者中应用更为安全,并且成本-效益更高.虽然PAV+对比传统模式优势明显,但由于其在临床应用推广有限及运用程度的不同,PAV+在危重患者中成功应用的时间尚短,能否将其作为辅助机械通气的主要模式尚不清楚.本文将对PAV+的作用机制及最新的研究进展进行综述.Controlled mechanical ventilation may be essential in the setting of severe respiratory failure,but some adverse effects may occur to affect the patients,so switching to assisted ventilation should be done as early as possible.Proportional assist ventilation with load-adjustable gain factors(PAV+)is an emerging mode of auxiliary ventilation,it is a ventilation model that does not require target tidal volume,flow rate or airway pressure,the pressure provided by the ventilator is proportional to the patient's instantaneous inspiratory effort,allowing the patient to comfortably meet his or her ventilation needs,when the patient's inspiratory flow rate stops,the ventilator will cease to ventilate and the inspiration ends.An ideal patient-ventilator interaction implies that the onset and end of patient's inspiratory cycle that can be properly detected,and the assistance delivered by mechanical ventilation is in synchrony and in proportion to the patient's demand and effort.The theoretical advantage of PAV+is improving patient-ventilator interaction.Due to its working principles,PAV+have the ability to provide self-adjusted lung and diaphragm-protective ventilation,which is also the purpose of the current treatment of mechanical ventilation.The research shows that compared with the conventional model,PAV+application is simple,time-saving and economic,and can reduce human-machine de-synchrony more effectively in critically ill patients,improve ventilator support to adapt the constantly changing of the patient's demand,promote offline and improve sleep quality,oxygenation and cardiac index,etc.In clinical application,PAV+can automatically monitor the platform pressure and automatically adjust the drive pressure,making it safer and cost-henefit higher in spontaneously breathing patients.Although PAV+has obvious advantages over the traditional model,due to its limited clinical application,promotion and different degrees of utilization,the time of using PAV+successfully for critically ill patients is short,so it is not clea

关 键 词：带有负载可调增益因子比例辅助通气 压力支持通气 机械通气 

分 类 号：R47[医药卫生—护理学]