AVAPS通气模式联合TCM监测在慢性阻塞性肺疾病急性加重期患者脱机中的应用价值  

Clinical application of AVAPS ventilation mode combined with TCM monitoring in weaning patients with AECOPD

作　　者：孙才智[1] 朱晨晨 秦海东[1] 鲍磊[1] SUN Caizhi;ZHU Chenchen;QIN Haidong;BAO Lei(Department of Emergency,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院急诊科,江苏南京210006

出　　处：《临床肺科杂志》2024年第12期1783-1787,共5页Journal of Clinical Pulmonary Medicine

基　　金：江苏省医院协会医院管理创新研究课题(No.JSYGY-3-2023-262);南京市医学科技发展计划项目(No.YKK22115)。

摘　　要：目的探讨AVAPS通气模式联合经皮氧/二氧化碳检测仪(TCM)监测在慢性阻塞性肺疾病急性加重(AECOPD)患者有创-无创序贯通气中的应用价值。方法选取行有创通气的老年慢阻肺患者120例,根据无创呼吸机的不同通气模式,将患者脱机后随机分为S/T组及AVAPS组,每组患者60例。所有患者在“出窗”时记录呼吸频率(RR)、心率(HR)、血氧饱和度(SpO_(2))、吸氧浓度(FiO_(2))、序贯性器官功能衰竭评分(SOFA)、白细胞总数、降钙素原、血小板、白蛋白及肌酐等指标,并记录无创机械通气6h后呼吸频率(RR)、心率(HR)、血氧饱和度(SpO_(2))及吸氧浓度(FiO_(2))等指标。同时记录二氧化碳分压(PaCO_(2)),行经皮二氧化碳分压(PtcCO_(2))监测,比较PtcCO_(2)与PaCO_(2)的相关性及治疗前后各生理参数的差异。比较两组患者48h再插管率、距插管时间、ICU住院时间。分析撤机后行无创机械通气6h后PtcCO_(2)变异度对48h再插管的预测效能。结果两组患者“出窗”时各生理参数及PtcCO_(2)值,均无统计学差异(P>0.05)。与S/T组比较,无创通气6h后,AVAPS组的生理参数RR、HR、PtcCO_(2)变异度及ROX指数均有所改善,差异有统计学意义(P<0.05),且AVAPS组的48h再插管率优于S/T组,且距插管时间更长(P<0.05)。ROC曲线分析显示,通气6h后的PtcCO_(2)变异度对AVAPS组患者48h再插管具有一定的诊断效能,其敏感度为92.30%,特异度为82.60%,AUC为0.898。结论AVAPS通气模式联合PtcCO_(2)在重症慢阻肺有创-无创“序贯”治疗的运用,能有更好的生理参数,更低的再插管率,以及更为优势的“人机协调性”。Objective To explore the application of AVAPS ventilation mode combined with TCM monitoring in invasive-noninvasive sequential ventilation in severe COPD patients.Methods 120 elderly COPD patients with invasive ventilation were selected.According to different modes of non-invasive ventilator,they were randomly divided into the S/T group and the AVAPS group,with 60 patients in each group.At the time of"out of the window"and 6 hours after ventilation,all patients recorded their RR,HR,SpO_(2),FiO_(2),white blood cell count,procalcitonin,platelets,albumin and creatinine.At the same time,PaCO_(2)detected by blood gas analysis and PtcCO_(2)was monitored,the correlation between PtcCO_(2)and PaCO_(2)was analyzed,and the differences of physiological parameters before and after treatment were compared.The 48-hour re-intubation rate,the time from intubation and the hospitalization time in ICU were compared between the two groups.The accuracy of PtcCO_(2)variability after 6 hours of ventilation in predicting 48 hours of re-intubation was analyzed.Results Compared with"out of the window",all physiological parameters and PtcCO_(2)values were optimized(P<0.05),and the difference was statistically significant.Compared with the S/T group after 6 hours of noninvasive ventilation,the physiological parameters RR,HR,ROX index and PtcCO_(2)variability in the AVAPS group were more optimized,and the difference was statistically significant(P<0.05).Moreover,the 48-hour re-intubation rate in the AVAPS group was better than that in the S/T group,and the time from intubation was longer(P<0.05).ROC curve analysis showed that the variability of PtcCO_(2)after 6 hours of ventilation had a certain diagnostic efficacy in predicting 48 hours of re-intubation,with a sensitivity of 92.30%,a specificity of 82.60%and an AUC of 0.898.Conclusion The application of AVAPS ventilation mode combined with PtcCO_(2)in the invasive-noninvasive sequential treatment of COPD can have better physiological parameters,lower re-intubation rate and better“man-machi

关 键 词：慢性阻塞性肺疾病急性加重 有创-无创序贯 经皮氧/二氧化碳检测仪监测 经皮二氧化碳分压 

分 类 号：R563.9[医药卫生—呼吸系统]