适应性支持通气在重症哮喘合并呼吸衰竭患者中的应用

Application of Adaptive Support Ventilation in Mechanically Ventilated Patients with Severe Asthma with Respiratory Failure

目的观察适应性支持通气在重症哮喘合并呼吸衰竭患者中的应用价值。方法纳入2008年至2013年淮安市第二人民医院ICU收治的重症哮喘合并呼吸衰竭病人60例,随机分为两组,每组30例,分别给予适应性支持通气(ASV)及同步间隙性指令通气(SIMV)加压力支持通气(PSV)两种通气模式。比较两组机械通气后的呼吸力学、血气等指标。结果与SIMV组比较,ASV组潮气量(V T)显著增加[(627.3±58.8)mL比(430.5±76.8)mL,P<0.01],而呼吸频率明显下降[(15.5±3.6)次/min比(22.3±2.8)次/min,P<0.01],气道峰压(PIP)显著下降[(2.31±0.60)kPa比(3.31±0.82)kPa,P<0.05],平均气道压无明显改变(Pm)[(0.74±0.68)kPa比(0.77±0.25)kPa,P>0.05],吸气阻力(R)显著下降[(1.51±0.52)kPa·L-1·s-1比(2.35±0.24)kPa·L-1·s-1,P<0.05]。ASV组器械附加功(WOBimp)(0.02 J/L比0.06 J/L,P<0.01)和吸气压力时间乘积(PTP)(0.027 kPa·s比0.051 kPa·s,P<0.01)均较SIMV组明显降低,带机时间明显缩短[(7.2±2.1)d比(9.5±2.9)d,P<0.05]。SIMV和ASV两种呼吸模式下血气分析、心率差异无统计学意义(P>0.05)。结论与传统的SIMV模式相比,ASV可以降低呼吸功并改善高通气力学,缩短带机时间,推荐用于重症哮喘合并呼吸衰竭患者。

Objective To investigate the value of adaptive support ventilation in patients with severe asthma with respiratory failure. Methods 60 patients with severe asthma with respiratory failure admitted between 2008 and 2013 were randomly divided into two groups with 30 cases in each group. They were treated with adaptive support ventilation （ASV） and synchronized intermittent mandatory ventilation （SIMV） plus pressure support ventilation （PSV） respectively. Respiratory mechanics,blood gas and other indicators between two groups were compared. Results Compared with the SIMV group, tidal volume （VT ） in the ASV group increased significantly [ （ 627.3 ± 58.8 ） mL vs. （ 430.5 ± 76. 8 ） mL, P 〈 0. 01 ], respiratory rate （RR） decreased [ （ 15.5 ± 3.6 ）/min vs. （ 22. 3 ± 2. 8 ）/min, P 〈 0. 01 ], peak inspiratory pressure （PIP） decreased [ （2. 31 ±0. 60） kPa vs. （3.31 ±0. 82） kPa,P 〈0. 05] ,mean airway pressure （Pro） didn＇t changed significantly [ （ 0. 74± 0.68 ） kPa vs. （ 0. 77 ± 0. 25 ） kPa, P 〉 0.05 ], inspiratory resistance（R） decreased significantly [ （1.51 ±0. 52） kPa · L^-1· s^-1 vs. （2. 35 ±0. 24） kPa · L^-1· s^-1 , P 〈 0. 05 ]. In the ASV group, the patients＇ work of breathing （WOB） （0. 02 J/L vs. 0. 06 J/L, P 〈 0. 01 ） and cross product of inspiratory time and pressue （PTP） （0. 027 kPa · s vs. 0. 051 kPa · s,P 〈0. 01 ） were significantly lower than those in the SIMV group, and duration of ventilation was significantly shorter [ （7. 2 ±2. 1 ） d vs. （9. 5± 2. 9） d, P 〈 0. 05 ]. Blood gas analysis data and heart rate were not significantly different （P 〉 0. 05）. Conclusions Compared with the traditional mode SIMV,ASV can reduce the work of breathing and improve high ventilation mechanics,shorten ventilator time. So ASV is suitable for patients with severe asthma with respiratory failure.