适应性支持通气模式与常规通气模式的临床对比研究

Clinical Comparative Study of Adaptive Support Ventilation and Pressure-controlled Assist/Control Ventilation on Respiratory Failure

目的通过适应性支持通气(ASV)模式与压力控制下的辅助/控制通气(PCMV)模式的对比研究,评价ASV的临床应用价值。方法各种原因导致的急性呼吸衰竭患者12例,所有患者均行气管插管,存在自主呼吸。按PCMV1-ASV-PCMV2顺序行机械通气;前后两次PCMV的设置不变。ASV模式行机械通气时,调整分钟通气量百分比(MV%)和患者理想体重(IBW),使之达到和PCMV机械通气时相同的分钟通气量,并记录各项指标。比较每次机械通气后45min的血气分析、呼吸力学、患者所做的功(WOB)、气道闭合压(P0.1)、吸气时间压力乘积(PTP)以及血流动力学等各项指标。结果前后两次PCMV模式机械通气后各项指标无明显差异(P>0.05)。ASV与第1次的PCMV相比,各项血气分析及呼吸力学指标无显著差异;患者所做的呼吸功(WOB)、气道闭合压(P<0.1)、吸气时间压力乘积(PTP)则明显降低(P<0.05);各项血流动力学指标无显著差异(P>0.05)。结论 ASV能获得与常规通气模式相似的通气目标,在减少患者的做功,降低中枢呼吸驱动方面较PCMV具有优越性。

ObjectiveTo compare adaptive support ventilation （ASV） and pressure-controlled assist/control ventilation （PCMV） and evaluate the clinical effects of ASV. Methods12 cases of acute respiratory failure patients induced by all causes were selected in the study. All patients with breathing independently underwent endotracheal intubation. The patterns of mechanical ventilation was PCMV-ASV-PCMV. the two settings of PCMV were uniformity. With ASV mode mechanical ventilation, we adjusted the percentage of minute ventilation （MV%） and ideal body weight （IBW） of patients, so as to reach the same minute ventilation volume of PCMV. We compared the blood gas, respiratory mechanics, work of breathing（WOB）, airway occlusion pressure （P〈0.1）, inspiratory pressure time product （PTP）, and hemodynamic of PCMV after 45 min.ResultsThe results of two patterns before and after PCMV showed no significant differences （P〉0.05）. Compared with the first of PCMV, various indicators and blood gas of ASV had no significant difference, work of breathing （WOB）, airway occlusion pressure （P=0.1） and inspiratory pressure time product （PTP） were significantly lower （P〈005）; and the hemodynamic indexes was of no significant difference （P〉0.05）. ConclusionASV can get similar goals with conventional ventilation, and reduce patient′s effort and the central respiratory drive.