成比例辅助通气与压力支持通气对自主呼吸试验患者效果交叉设计研究

Effects of pressure assist ventilation and pressure support ventilation on spontaneous breathing trial:a cross-over study

目的比较成比例辅助通气(proportional assist ventilation plus,PAV+)与压力支持通气(pressuresupport ventilation,PSV)两种不同的自主通气模式对患者呼吸、循环系统的影响。方法对所有符合纳入标准的患者,采用自身对照、交叉设计的方法,随机选择通气模式,分别采用PAV+与PSV模式进行30 min SBT,监测并记录患者在SBT前与SBT结束时的心率(HR)、平均动脉压(MP)、脉搏氧饱和度(SpO_2)、呼出潮气量(Vte)、平均气道压(MAP)、呼吸浅快指数(RSBI)等参数,以及SBT前后的动脉血气分析等指标。结果 SBT结束时,PAV组和PSV组的呼吸、循环相关参数比较,与PSV组相比,PAV组在Vte较SBT前有所增加,有统计学意义(P<0.05),PAV组和PSV组增加量分别为(44.25±49.8)ml、(9.25±19.2)ml;PAV组在RSBI显著低于PSV组(P=0.041),PAV组和PSV组分别是(39±10)ml、(53±14)ml。与PSV组相比,PAV组其余指标无显著性差异(P>0.05)。SBT后30min动脉血气分析结果在两组无显著性差别(P>0.05)。结论与PSV模式相比较,PAV+模式下,Vte、MV等参数较SBT前有所增加;RSBI在PAV组显著低于PSV组;循环系统两者无显著性差异。

Objective To compare the effects of pressure assist ventilation ＋ （PAV ＋ ）mode and pressure support ventilation （PSV） mode on respiration and circulation in patients undergoing spontaneous breathing trial （SBT）. Methods Cross-over design method was applied in this study. All the patients included underwent and completed two SBTs of PAV ＋ and PSV. These two different ventilation modes sequence were set randomly. SBTs were completed in 30 min. Ventilatory and circulatory parameters were monitored and recorded before and after the SBT procedures, including Heart Rate （HR）, mean pressure （MP）, pulse oximetry （SpO2 ）, tidal volume （Vte）, minute ventilation （MV）, mean airway pressure （MAP）, rapid shallow breathing index （RSBI）, arterial blood gas analysis （ABG）. Results Comparing to PSV mode, PAV ＋ mode delivered more Vte and MV during the SBT procedures （ 44.25±49.8 ml vs 9.25 ± 19.2 ml, P 〈0.05 ; 0.88 ±0.4 ml vs - 0.71 ± 1.9 ml, P 〈0.05, respectively） ; PAV ＋ mode has lower RSBI at the end of the 30 rain SBT procedures （39 ± 10 ml vs 53 ± 14 ml, P=0.041 ）. Other respiration, circulation parameters and ABG at baseline and end of SBT between PAV ＋ and PSV modes showed no significant differences （ P 〉 0.05）. Conclusion When patients performed SBT procedures, PAV ＋ mode can deliver more Vte and MV than PAV mode. PAV ＋ mode has lower RSBI at the 30 rain of the SBT procedures.