APRV与PCV通气模式对ARDS患者的疗效研究  

Efficacy of APRV and PCV ventilation modes in patients with acute respiratory distress syndrome(ARDS)

作　　者：夏米西丁·阿尔斯兰[1] 里提甫江·买买提艾力 刘米莉 艾尔西丁·吾斯曼[1] Xiamixiding Aersilan;Litifujiang Maimaitiaili;LIU Mili;Aierxiding Wusiman(Center of Xinjiang Emergency,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院新疆急救中心,乌鲁木齐830001

出　　处：《新疆医科大学学报》2023年第4期460-464,共5页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区特培项目(2019D03026)。

摘　　要：目的比较压力释放通气模式(Airway pressure release ventilation,APRV)与机械压力控制通气模式(Pressure control ventilation,PCV)治疗急性呼吸窘迫综合征(Acute respiratory distresssyndrome,ARDS)患者的疗效。方法选取2019年12月-2021年10月在新疆维吾尔自治区人民医院新疆急救中心收治的54例ARDS患者为研究对象,随机分为两组为,每组27例。APRV组Phigh设为最佳PEEP下测得的Pplat,且不超过30 cmH2O,Plow设为5 cmH2O,Tlow(低压持续时间)=1.0 s,Thigh(高压持续时间)=4.0 s,f设置为12次/min,调节呼气末流速>50%呼气峰流速,释放频率为10~14次/分,通过镇痛镇静调整,保留部分自主呼吸。PCV组患者接受PCV通气,目标潮气量设置为6~8 mL/kg,依据ARDSnet协议调节呼气末正压(PEEP)水平、FiO_(2)水平和呼吸频率。记录两组患者的一般资料,比较机械通气前,通气第一天血气功能指标、血流动力学指标、评价APACHEⅡ评分、肺损伤(Murray)评分、镇静镇痛药物使用情况以及预后的情况。结果与本组治疗前比较,治疗后患者PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)指标升高,差异有统计学意义(P<0.05)。与PCV组治疗后比较,APRVA组治疗后PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)指标升高,HR、MAP、CVP和ELWI指标降低,Murray评分和镇静药物使用剂量下降,住院时间、住ICU时间以及机械通气时间缩短,差异均有统计学意义(P<0.05);APACHEⅡ评分、拔管成功率、ICU住院时间和转出ICU28天死亡率均无明显改善,差异均无统计学意义(P>0.05)。结论ARDS患者早期使用APRV治疗效果更佳。Objective To compare the efficacy of pressure relief ventilation(APRV)and mechanical pressure control ventilation(PCV)in the treatment of the patients with acute respiratory distress syndrome(ARDS).Methods 54 patients with ARDS admitted to the hospital from December 2019 to October 2021 were selected as the study subjects and randomly divided into two groups of 27 patients each.Phigh in the APRV group was set to the Pplat measured under optimal PEEP and at most 30 cmH_(2)O;Plow was set to 5 cmH_(2)O in the APRV group,Tlow(low-pressure duration)=1.0 s,Thigh(high-pressure duration)=4.0 s;f was set to 12 breaths/min;and the end-expiratory flow rate was adjusted to>50%of the peak expiratory flow rate;the release frequency was 10-14 breaths/min;and some of the spontaneous breathing were preserved through the analgesic sedation adjustment;the patients in PCV group received PCV ventilation,and the target tidal volume was set to 6-8 mL/kg.The patients in the PCV group received PCV ventilation with a target tidal volume set at 6-8 mL/kg,and positive end-expiratory pressure(PEEP)level;FiO_(2)2 level and respiratory rate was adjusted according to the ARDSnet protocol.The general data of the patients in both groups were recorded,and their blood gas function indexes,hemodynamic indexes,APACHEⅡscore,lung injury(Murray)score,sedative and analgesic drug use,and prognosis were compared before and on day 1 of mechanical ventilation.Results Compared with the group before the treatment,the indexes of PaO_(2)2,SaO_(2)2,PaO_(2)2/SiO_(2)2 in patients after the treatment were increased significantly(P<0.05).Compared with the PCV group after the treatment,the indexes of PaO_(2)2,SaO_(2)2,PaO_(2)2/SiO_(2)2 in APRVA group were increased,while the indexes of HR,MAP,CVP,and ELWI were decreased.The Murray score and the dosage of sedative drugs were decreased,and the hospital stay,ICU stay,and mechanical ventilation time was decreased in APRVA group after the treatment,with significant differences(P<0.05).The APACHEⅡscore,the success rate

关 键 词：压力释放通气模式 压力控制模式 急性呼吸窘迫综合征 疗效 

分 类 号：R563[医药卫生—呼吸系统]