适应性支持通气在体外循环下心脏手术患者脱机中的研究

The Weaning Study on Adaptive Support Ventilation for the Patients After Cardiac Surgery of Extracorporeal Circulation

目的:通过比较ASV和SIMV+PSV模式在体外循环下心脏手术后患者脱机中的研究,为临床寻找一个更合适的脱机模式。方法:将我院2010年1月-2011年12月期间体外循环下行非复杂心脏外科手术者(包括房间隔缺损、室间隔缺损、二尖瓣置换术、主动脉瓣置换术)纳入研究。体外循环心脏手术后患者常规转入ICU,使用随机数字表随机分为两组(ASV组和SIMV+PSV组),分别给予ASV和SIMV+PSV两种通气模式,并按标准的脱机程序脱机。术后比较两组患者机械通气时间、住ICU时间、血气分析、呼吸力学指标、血流动力学指标、呼吸机报警次数、人工操作次数、生命体征等指标。结果:共31例患者完成该研究,其中ASV组16例,SIMV+PSV组15例。ASV组与SIMV+PSV组相比,机械通气时间[(223.9±22.1)min VS(302.9±30.2)min]、呼吸机报警次数[(2.0±1.3)bpmVS(4.0±1.8)bpm]人工操作次数[(4.8±1.4)bpm VS(8.2±3.4)bpm],两组相比具有统计学差异。呼吸力学指标:ASV组与SIMV+PSV组相比,气道峰值压力[(15.8±1.4)cmH2O VS(20.4±1.3)cmH2O],两组相比具有统计学差异。而血流动力学以及血气分析结果相比无统计学差异。结论:ASV模式能加速气管插管的拔除,简化操作,ASV模式作为一个脱机模式安全有效。

Objective：To compare the different characteristics of ASV and SIMV＋PSV mode in the extubation after cardiac surgery and search a more suitable weaning mode for the clinical practice.Methods：The uncomplicated patients（including atrial septal defect,interventricular septal defect,valve replacement） after cardiac surgery from January 2010 to December 2011 were included.The patients after cardiac surgery were transferred to ICU.We used the random digits table,and the patients were randomly divided into two groups：ASV group and SIMV＋PSV group.According the standard procedure,the patients were extubated.The duration of mechanical ventilation,the duration of ICU stay,blood gas analysis and condition of breathing mechanics and hemodynamics,ventilator alarms,manual ventilator settings manipulations before extubation and vital sign was compared.Results：31 patients including 16 patients in ASV group and 15 patients in SIMV＋PSV group completed the study.Parameter in ASV group was respectively the duration of mechanical ventilation[（223.9±22.1）min VS（302.9±30.2）min],ventilator alarm[（2.0±1.3）bpm VS（4.0±1.8）bpm],ventilator settings manipulations[（4.8±1.4）bpm VS（8.2±3.4）bpm]compared with that in SIMV＋PSV group（P0.05）.Condition of breathing mechanics：the peak pressure in ASV group（15.8±1.4） cmH2O was significantly lower than that（20.4±1.3）cmH2O in SIMV＋PSV group.But the parameter in hemodynamics and blood gas analysis was not significantly different.Conclusion： ASV mode could accelerate the extubation after cardiac surgery and simplify the manipulation.ASV mode is very safe and effective as a weaning mode.