慢性呼吸衰竭患者无创比例辅助通气和压力支持通气的比较

A prospective randomized study on noninvasive pressure support versus proportional assist ventilation in chronic respiratory failure

目的比较无创比例辅助通气(PAV)和压力支持通气(PSV)治疗慢性呼吸衰竭患者的疗效和依从性。方法20例稳定期慢性阻塞性肺疾病(COPD)呼吸衰竭患者随机选用PAV或PSV,记录患者动脉血气、平均潮气量(VT)、分钟通气量(VE)、气道峰压(PIP)和夜间通气时间;采用视觉模拟评分(VAS)评价通气舒适性、睡眠状况和不良反应。结果PAV和PSV治疗组VE和VT比较无显著差异(P均>0.05),PAV组PIP较低[(12.2±2.4)cm H2O比(15.6±3.8)cm H2O,P<0.05];PAV组夜间通气时间较长[(3.3±0.7)h比(2.6±0.5)h,P<0.05],口鼻咽干燥程度较轻[(3.6±0.7)分比(4.5±0.9)分,P<0.05],口腔漏气较少[(3.3±0.6)分比(4.4±0.8)分,P<0.01]。结论慢性呼吸衰竭患者无创PAV依从性较好。

Objective To compare the effects and compliance of noninvasive proportional assist ventilation （PAV） and pressure support ventilation （PSV） in the treatment of chronic respiratory failure （CRF）. Methods PAV and PSV were randomly applied in 20 patients in clinically stable condition with CRF due to COPD. The average tidal volume （VT）, minute ventilation （VE）, peak inspiratory pressure （PIP） and nocturnal ventilation time were recorded during ventilation. The sleep quality, ventilation comfort and side effects were evaluated by visual analog scale （VAS）. Results There were no significant differences in VE and VT between PAV and PSV （ P 〉 0.05）. The PIP was slightly lower during PAV [ （ 12.2 ± 2.4 ） cm H2O vs （ 15.6 ± 3.8） cm H2O, t = 2.391, P 〈 0.05 ]. Nocturnal ventilation time significantly prolonged in PAV [ （3.3 ± 0.7） h vs （2.6 ± 0.5）h, P〈 0.05].The VAS score showed that the degree of nasal and pharynx dryness [（3.6 ± 0.7） vs （4.5 ± 0.9 ）, P 〈 0.05 ] as well as oral air leak [ （3.3 ± 0.6 ） vs （ 4.4 ± 0.8）, P 〈 0.01 ] were milder in PAV as compared to PSV. Conclusion Noninvasive PAV shows better patient compliance in CRF.