不同通气模式治疗慢性阻塞性肺疾病合并呼吸衰竭临床疗效及患者呼吸动力学、肺功能水平比较  

Comparison of clinical efficacy of different ventilation modes in treatment of patients with respiratory diseases based on respiratory dynamics and pulmonary function level

作　　者：王雅宁 米婷[3] 周红 WANG Yaning;MI Ting;ZHOU Hong(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院呼吸与危重症医学科,陕西西安710061 [2]宝鸡市第二人民医院呼吸内科,陕西宝鸡721004 [3]西安医学院附属宝鸡医院呼吸与危重症医学科,陕西宝鸡721004

出　　处：《陕西医学杂志》2023年第1期36-39,44,共5页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2018JM7132)。

摘　　要：目的:探究采用不同通气模式对呼吸系统疾病患者进行治疗的临床疗效,并分析其对患者呼吸动力学以及肺功能指标的影响,为临床治疗提供理论依据。方法:收集收治的116例慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者作为研究对象,并根据通气模式将其分为同步间歇指令通气(SIMV)+压力支持通气(PSV)组和适应性压力支持通气(ASV)组各58例。①记录并比较两组患者治疗前后血气指标变化情况;②比较两组患者治疗后呼吸动力学指标(Ppeak、Pplat、Pmean)变化情况;③比较两组患者治疗前后肺功能相关指标变化情况;④记录两组患者不良反应的发生情况。结果:①治疗前ASV组与SIMV+PSV组患者pH值、血氧分压(PaO_(2))、血二氧化碳分压(PaCO_(2))以及动脉血氧分压与吸入气氧浓度的比值(PaO_(2)/FiO_(2))比较无统计学差异(均P>0.05);治疗后两组患者pH值无显著变化(均P>0.05),PaO_(2)、PaO_(2)/FiO_(2)明显升高(均P<0.05),PaCO_(2)明显降低(P<0.05),但治疗后组间比较无统计学差异(均P>0.05);②治疗后,ASV组患者Ppeak、Pplat、Pmean等各项呼吸动力学指标均明显低于SIMV+PSV组患者,组间比较差异有统计学意义(均P<0.05);③治疗前ASV组与SIMV+PSV组患者1s用力呼气末容积(FEV1)、用力肺活量(FVC)以及呼气高峰流量(PEFR)比较无统计学差异(均P>0.05);治疗后两组患者FEV1、FVC以及PEFR均明显升高(均P<0.05),且治疗后组间比较差异有统计学意义(均P<0.05);④与SIMV+PSV组患者相比,ASV组患者不良反应以及呼吸机相关性肺炎的发生例数均有减少,总发生率明显降低(均P<0.05)。结论:对COPD合并呼吸衰竭患者进行治疗时,与SIMV+PSV通气模式相比,采用ASV通气模式具有更好的临床疗效,能够显著改善患者肺功能状况,明显提高患者呼吸动力学稳定性,也能显著降低患者不良反应的发生风险。Objective:To explore the clinical efficacy of different ventilation modes in the treatment of patients with respiratory system diseases,and to analyze its influence on the respiratory dynamics and pulmonary function indexes of patients,so as to provide a theoretical basis for clinical treatment.Methods:A total of 116 patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure were collected and divided into SIMV+PSV group and ASV group(58 cases in each)according to ventilation mode.The changes of blood gas indexes,pulmonary function-related indexes and adverse reactions of the two groups before and after treatment were recorded and compared.The changes of respiratory dynamics indexes(Ppeak,Pplat and Pmean)of the two groups after treatment were compared.Results:Before treatment,there was no significant difference in pH,PaO_(2),PaCO_(2) and PaO_(2)/FiO_(2) between ASV group and SIMV+PSV group(all P>0.05).After treatment,there was no significant change in pH between two groups(P>0.05),while PaO_(2) and PaO_(2)/FiO_(2) were increased significantly(all P<0.05),and PaCO_(2) decreased significantly(P<0.05),but there was no significant difference between two groups(all P>0.05).The respiratory dynamics indexes such as Ppeak,Pplat and Pmean in the ASV group were significantly lower than those in the SIMV+PSV group after treatment(P<0.05).Before treatment,there was no significant difference in FEV1,FVC and PEFR between ASV group and SIMV+PSV group(all P>0.05).After treatment,FEV1,FVC and PEFR in two groups were significantly increased(all P<0.05),and there was significant difference between two groups(all P<0.05).Compared with the SIMV+PSV group,the ASV group had fewer adverse reactions and ventilator-associated pneumonia,and the overall incidence was significantly lower(P<0.05).Conclusion:In the treatment of COPD patients with respiratory failure,compared with SIMV+PSV ventilation mode,the use of ASV ventilation mode has better clinical efficacy,can significantly improve the patient’s pulmo

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 呼吸动力学 肺功能 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[医药卫生—呼吸系统]