双相气道正压通气与同步间歇指令通气对急性呼吸窘迫综合征的治疗作用

The therapeutic effects of biphasic positive airway pressure mechanical venti-lation in patients with acute respiratory distress syndrome compared with synchronous intermittent mandatory ventilation

目的:探讨双相气道正压(BIPAP)通气模式与同步间歇指令通气(SIMV)治疗急性呼吸窘迫综合征(ARDS)的疗效。方法:将26例ARDS患者随机分为BIPAP组和SIMV组行机械通气治疗,每组13例。每种模式通气6h,稳定后分别记录两组的呼吸力学指标(RR、Vte、PIP、Pmean、Crs)、氧动力学指标(PaCO2、PaO2、SaO2、PaO2/FiO2)和血流动力学指标(HR、CVP、ABPM)。结果:两组的呼吸力学指标:RR、PIP、PmeanBIPAP组低于SIMV组(P<0.05),而CrsBIPAP组高于SIMV组(P<0.05);氧动力学指标:PaO2、PaO2/FiO2BIPAP组高于SIMV组(P<0.05);血流动力学指标:HR、CVP、ABPM两组差异无统计学意义(P>0.05)。结论:BIPAP通气模式人机协同性好,肺损伤小,可改善氧合及呼吸力学效应,治疗ARDS优于SIMV。

Objective： To explore the effect of biphasic positive airway pressure （BIPAP） mechanical ventilation on patients with acute respiratory distress syndrome （ARDS） compared with synchronous（ARDS） intermittent mandatory ventilation （SIMV）. Methods： Twenty-six ARDS patients were randomly divided into BIPAP group and SIMV group, with 13 patients in each group. The indexes of respiratory mechanics （RR, Vte, PIP, Pmean and Crs）, oxygen kinetic （PaCO2, PaO2, SaO2, PaO2/FiO2） and hemodynamic parameters （FIR, CVP, ABPM） were recorded in both groups after each mechanical ventilating for six hour. Resuits： RR, PIP and Pmean in BIPAP group were lower than those in SIMV group （P〈0.05）, but Crs in BIPAP group was higher than that in SIMV group （P〈0.05）; PaO2 and PaOJFiO2 in BIPAP group were higher than those in SIMV group （P〈0.05）; HR, CVP and ABPM had no difference in two groups （P〉0.05）. Conclusion： BIPAP is an effective mode of mechanical ventilation therapy for ARDS patients, better than SIMV.