适应性支持通气模式在颈髓损伤后呼吸衰竭患者中的应用

Adaptive support ventilation in respiratory failure after cervical spinal cord injury

目的：比较颈髓损伤后呼吸衰竭患者使用适应性支持通气（ASV）模式与同步间歇指令通气（SIMV）模式机械通气的治疗效果。方法：收集2007年1月至2010年1月本院重症医学科室治疗的颈髓损伤合并呼吸衰竭患者30例，应用ASV模式机械通气1h后转为SIMV模式。应用每种模式，均待患者呼吸平稳30Min后开始每10min记录患者心率、呼吸频率、平均动脉压及呼吸力学指标的变化，连续记录3次．进行血气分析检测并询问记录患者的主观舒适度。结果：2种通气模式下，患者的心率、平均动脉压及呼吸力学指标差异均无统计学意义（P〉0．05），血气分析显示患者的pH值、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）差异均无统计学意义（P〉0．05）。ASV模式与SIMV模式机械通气比较，前者患者的主观舒适度较高[（2．4±1．2）分比（6．6±2．0）分，P〈0．01]。结论：ASV模式较SIMV模式机械通气更适合颈髓损伤后呼吸功能不全患者的治疗。

Objective： To compare the effect of adaptive support ventilation （ASV） and synchronized intermittent mandatory ventilation （SIMV） in patients with respiratory failure after cervical spinal cord injury. Methods ：Thirty patients with cervical spinal cord injury and respiratory failure, admitted to our department between January 2007 and January 2010, received ASV for lh which was converted to SIMV thereafter. Heart rate, respiratory rate, mean arterial pressure and the parameters of respiratory mechanics were recorded every 10 minutes, fur 3 times in total, after the patients were experiencing stable respiration for 30 minutes. Besides, blood gas analysis was performed and subjective comfort enquired in the patients under both ASV and SIMV. Results： There were no significant differences in heart rate, mean arterial pressure and parameters of respiratory mechanics of the patients under ASV versus SIMV. By blood gas analysis, pH value, PaO2 and PaCO2 did not differ under either mode of ventilation （ P 〉 0.05 ）. Patients felt more comfortable under ASV than under SIMV [ （2.4±.2） vs （6.6±2.0）, P 〈0.01]. Conclusion： ASV appeared more suitable than S1MV for treatment of respiratory failure after cervical spinal cord injury.