适应性支持通气在呼吸衰竭中的应用

The effect of the adaptive support ventilation in respiratory failure

目的:探讨适应性支持通气(ASV)在呼吸衰竭患者中的临床价值。方法:选择需要机械通气的呼吸衰竭患者58例,将其随机分为两组,观察组(ASV)29例,对照组29例采用同步间竭指令通气+压力支持通气(SIMV+PSV),两组同时进行机械通气治疗直至撤机,记录比较两种模式下的各项呼吸力学及血流动力学参数、血气分析、舒适程度、通气时间和撤机成功率。结果:全部患者均成功脱机,呼吸频率明显下降,潮气量(VT)明显升高(P<0.05),气道峰压(Ppeak)和吸气阻力(R)下降显著(P<0.05),静脉顺应性(Cstat)逐渐增加(P<0.05)。ASV通气患者的上机时间明显缩短(P<0.05)。结论:ASV可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量,降低呼吸频率,而对血流动力学和生命体征没有影响,并能缩短上机时间,明显优于常规通气,而且操作简单,值得临床大力推广应用。

Objective：To investigate the clinical value of the adaptive support ventilation （ASV） in patients with respiratory failure. Methods： 58 cases with respiratory failure needed mechanical ventilation were randomly divided into two groups, the observation group （ASV） for 29 cases, 29 cases of the control group between synchronized mandatory ventilation exhaust ventilation ＋ pressure support （SIMV ＋ PSV）, two groups at the same time mechanical ventilation until weaning, compared records of the two modes of respiratory mechanics and hemodynamic parameters, blood gas analysis, comfort, ventilation time and the success rate of weaning. Results：All patients were successfully offline, significantly reduced respiratory frequency, tidal volume （VT） increased significantly （P〈0.05）, peak airway pressure （Ppeak） and inspiratory resistance （R） decreased significantly （P〈0.05）, intravenous compliance （Cstat） gradually increased （P〈0.05）. ASV machine ventilation on patients with significantly shortened （P〈0.05）. Conclusion：ASV under conditions of respiratory mechanics in patients with auto-adjust at the level of inspiratory pressure support and enhance tidal volume, reducing respiratory rate, and on hemodynamies and do not affect vital signs, and can shorten the time the machine, it is obviously superior to conventional ventilation, and easy to operate and is worth to promote the clinical application.