适应性支持通气与传统通气模式在急性肺出血并呼吸衰竭中的应用比较

Comparison of Adaptive Support Ventilation and Conventional Ventilation in Treatment of Acute Respiratory Failure due to Pulmonary Hemorrhage

目的比较适应性支持通气（adaptive support ventilation，ASV）模式与同步间歇指令通气＋压力支持通气（SIMV＋PSV）模式（传统通气模式）对急性肺出血并呼吸衰竭患者的治疗价值。方法将急性肺出血并呼衰机械通气患者38例，信封法随机分为两组，分别采用ASV和SIMV＋PSV模式进行治疗直至撤机，比较两组的血液动力学参数、血气分析、呼吸力学和通气参数、机械通气时间、肺出血停止时间、撤机成功率及气压伤发生率的影响。结果（1）两组的血气分析和血液动力学指标无明显差异（P〉0．05），但ASV组较SIMV＋PSV组出血停止时间明显缩短（P〈0．05），两组撤机成功率均100％，无气压伤发生。（2）ASV组较SIMV＋PSV组，VT（潮气量）、PSV（压力支持水平）增加而RR（呼吸频率）明显减慢，差异有显著性（P〈0．01）；PIP（气道峰压）和Pplat下降显著（P〈0．01或P〈0．05），PEEPi（内源性呼气末正压）的发生率22．38％，明显低于SIMV＋PSV组的44．67％（P〈0．01），ASV组的通气时间亦明显减少（P〈0．05）。结论ASV模式应用于急性肺出血并呼衰患者，与传统SIMV＋PSV模式相比具有相同的改善氧合的效果，但呼吸力学的改善更有利于撤机和肺保护，减少肺出血的发生，而且操作较简单，值得临床推广应用。

Objective To compare and evaluate the application of ASV and SIMV ＋ PSV ventilation in the treatment of acute respiratory failure due to pulmonary hemorrhage. Methods The 38 patients of acute respiratory failure due to pulmonary hemorrhage were randomly divided into two groups, ASV treatment group （n = 18） and SIMV ＋ PSV group （ n = 20 ） . The respiratory monitoring parameters, arterial blood gases, and mean arterial blood pressure （MAP） were recorded, the time of ventilation and pulmonary hemorrhage , the rate of ventilation ceasing and ventilation lung injury were also recorded. Results 1, There was no difference between two groups in arterial blood gases, and MAP （ P 〉 0.05 ）, but the time of ventilation and pulmonary hemorrhage in ASV group was distinctly lower than the SIMV ＋ PSV （ P 〈 0.05 ） . The patients of two groups were all ceased successfully and had no lung injury. 2, The levels of peak airway pressure （ Ppeak ）, plate airway pressure （Pplate ）, respiratory frequency in ASV mode were greatly decreased than those in SIMV ＋ PSV mode （ P 〈 0.01 or P 〈 0.05 ）, there was significant difference between two groups （ P 〈 0.05） in the rate of PEEPi. Conclusion Compared ASV and SIMV ＋ PSV treatment for patients with pulmonary hemorrhage, on the base of the same changing in oxygen tension and carbon dioxide tension, the former can decrease the airway pressure and improve patient - ventilator compatibility, which is beneficial for the strategy of lung protection, and also more safe and beneficial in weaning ventilation. Furthermore, ASV is much easier to operate. It is worth to be popularized and applied in clinical working.