适应性支持通气模式在长期机械通气非COPD患者中的临床应用及护理对策

Clinical application of adaptive support ventilation on non-COPD patients of long-term ventilation and nursing strategy

目的探讨适应性支持通气（adaptive support ventilation，ASV）模式在长期机械通气非慢性阻塞性肺疾病（COPD）患者中的临床应用。方法选择长期机械通气的非COPD患者12例。应用ASV模式后，再转换为PS—SIMV模式，两种呼吸模式时每分钟通气量（MV）相同。均待患者呼吸平稳30min后，记录患者的呼吸力学指标，同时监测心率、血压及血气分析。应用ASV模式前做好心理护理，通气中保持气道通畅，湿化及吸痰等护理。结果12例非COPD患者应用ASV模式，与PS-SIMV模式比较，呼吸力学及动脉血气分析均无统计学意义气（P〉0．05），但应用ASV时，患者舒适程度更好。结论ASV模式减少患者的呼吸用力，人机协调性好，安全性好，心理护理及护理重点措施和经验在临床中可以推广应用。

Objective To study the clinical application of adaptive support ventilation （ASV） on non- COPD patients of long-term ventilation. Methods 12 elderly non-COPD patients of long-term ventilation were selected in elderly wards in our hospital from Jan. 2005 to Mar. 2006. Two modes in which minute volume （MV, volume per minute） was consistent were applied： ASV and PS-SIMV. In all modes for each used, until the patients came into a stable respiration for 30 min, the variables of respiratory mechanics were recorded, meanwhile the variables of hemodynamics and arterial blood analysis were measured. In addition, the gases in blood was analyzed by drawing blood from artery. A psychological nursing was well given before the use of ASV mode, and it needs to keep airway free and take the following nursing of humidification and sucking sputum. Results Compared with PS-SIMV, the variables of respiratory mechanics, hemodynamics and arterial blood analysis had no a statistically significant change in ASV for 12 non-COPD patients （ P 〉0. 05）. But, when using ASV, the patients felt more comfortable. Conclusions ASV mode can reduce the force exerted by patients when respirating, have a good compatibility between man and manchine, and show a high safety. The psychological nursing and the nursing key mearsures and the experiences may be extended and used in clinical applications.