BIPAP-SIMV-PSV与SIMV-PS-CPAP脱机方式的比较

Comparison of two weaning modes in patients with BIPAPSIMVPSV and SIMVPSCPAP

目的：比较双水平气道正压通气 同步间歇指令通气 压力支持通气（ＢＩＰＡＰ ＳＩＭＶ ＰＳＶ）与同步间歇指令通气 压力支持通气 持续气道正压（ＳＩＭＶ ＰＳ ＣＰＡＰ）两种脱机方式效果。方法：４９ 例呼吸衰竭患者按脱机方式不同分为：ＢＩＰＡＰ ＳＩＭＶ ＰＳＶ 脱机成功组（２２ 例）与失败组（３ 例），ＳＩＭＶ ＰＳ ＣＰＡＰ脱机成功组（１４例）与失败组（１０ 例）。各组对应参数进行Ｆ检验、ｑ检验。结果：采用ＢＩＰＡＰ ＳＩＭＶ ＰＳＶ 方式脱机与ＳＩＭＶＰＳ ＣＰＡＰ相比明显提高脱机成功率（８８％ 与５８％ ，Ｐ＜ ０．０５）。尤其在ＳＩＭＶ ＰＳ ＣＰＡＰ不能脱机患者应用ＢＩＰＡＰ ＳＩＭＶ ＰＳＶ 能实现脱机。ＳＩＭＶ ＰＳ ＣＰＡＰ以减频率方法；ＢＩＰＡＰ ＳＩＭＶ ＰＳＶ 脱机参数一般为：ＦｉＯ２ ＜ ０．４、Ｐｌｏｗ ＜ ０．４９ ｋＰａ（１ ｋＰａ＝ １０．２０ ｃｍ Ｈ２Ｏ）、Ｐｈｉｇｈ ＜ １．５７ ｋＰａ、ｆ４ 次／ｍ ｉｎ、Ｉ∶Ｅ＝ １∶４、Ｐｈｉｇｈ 与Ｐｌｏｗ 差０．４９～１．１８ ｋＰａ。结论：ＢＩＰＡＰ ＳＩＭＶ ＰＳＶ方式与ＳＩＭＶ ＰＳ ＣＰＡＰ相比是一种较好的脱机方式。

Objective:To compare the effects of two weaning modes in patients with biphasic intermittent positive airway pressuresynchronized intermittent mandatory ventilationpressure support ventilation (BIPAPSIMVPSV) and synchronized intermittent mandatory ventilationpressure support ventilationcontinuous positive airway pressure (SIMVPSCPAP).Methods:49 patients with respiratory failure were divided into two groups in which patients were weaning from BIPAPSIMVPSV and from SIMVPSCPAP modes,respectively.In BIPAPSIMVPSV modes,patients were subdivided into weaning successful ( n =22) and weaning falilure ( n =3) groups.Patients in SIMVPSCPAP modes were also subdivided into weaning successful ( n =14) and weaning failure ( n =10) groups.All resultes used t test for statistical analysis.Results:The rate for successful weaning in both groups were 88% and 58%,respectively,which showed a significant difference (χ 2=4 11, P <0 05).Ventilated patients with BIPAPSIMVPSV were weaned successfully,especially in patients without weaning in SIMVPSCPAP mode.When using SIMVPSCPAP mode,the frequency of SIMV should be decreased gradually.In order to get better weaning with BIPAPSIMVPSV mode,the following parameters should be followed:FiO 2<0 4,P low <0 49 kPa(1 kPa=10 20 cmH 2O),P high <1 57 kPa,f 4 breaths/minute,I∶E=1∶4,the difference between P high and P low is less than 0 49～1 18 kPa.Conclusions:BIPAPSIMVPSV mode is better for weaning than that of SIMVPSCPAP mode.