适应性支持通气对老年重症肺炎机械通气患者呼吸力学参数的影响

Effect of adaptive support ventilation on the indices of respiratory mechanics in elderly patients with severe pneumonia

目的 探讨适应性支持通气在老年重症肺炎呼吸衰竭患者中应用的临床意义. 方法 选择老年重症肺炎呼吸衰竭机械通气患者52例,将其随机分为两组,每组26例,治疗组患者接受适应性支持通气（ASV）,对照组同步间歇指令通气＋压力支持通气＋呼气末正压（SIMV＋ PSV＋PEEP组）,两组同时进行机械通气治疗直至撤机,比较两种模式下的呼吸力学指标变化. 结果 呼吸频率、吸气阻力、静态顺应性、潮气量、平台压、气道峰压、呼吸附加功、压力时间乘积.治疗组分别为（30.2±3.6）次/min、（13.2±1.2）cmH2O·L-1·S-1、（3 4.3±3.4） ml/cmH2O、（495.7±24.6）ml、（16.1±1.5）cmH2O、（36.2±3.7）cm H2O、（15.1±1.4）J/min、（0.3±0.0）cmH2O·S-1;对照组分别为（30.2±3.4）次/min、（19.3±1.6）cm H2O·L-1·S-1、（21.2±2.7）ml/cmH2O、（460.3±23.8）ml、（16.2±1.33）cmH2O、（25.9±2.17）cmH2O、（21.2±2.1）J/min、（0.4±0.0）cmH2O· S-1.同对照组比较,治疗组患者呼吸频率下降,潮气量升高（t=3.998,P＜0.05）,吸气阻力下降（t=3.902,P＜0.05）,静态顺应性增加（t=4.487,P＜0.05）,呼吸附加功和吸气压力时间乘积均低于对照组（t=4.951和4.842,P＜0.01）.平台压、气道峰压有所升高,但两组相比较差异无统计学意义（分别t=2.078,1.504,P＞0.05）,同时动脉血氧分压、氧合指数和二氧化碳分压两组相比较差异无统计学意义（分别t=2.099,1.894,2.487,P＞0 05）. 结论 相对于常规SIMV通气,适应性支持通气可提高患者潮气量,降低呼吸频率,呼吸肌做功减少,改善人机协调性.

Objective To investigate the effect of adaptive support ventilation on the indices of respiratory mechanics in elderly patients with severe pneumonia and its clinical value.Methods Fifty-two cases with respiratory failure undergoing mechanical ventilation were randomly divided into two groups （n=26,each）.The treatment group was assigned to adaptive support ventilation （ASV）,and control group were assigned to SIMV＋ PSV＋PEEP support.Patients in two groups were all ventilated until weaning.The changes in respiratory mechanics indices were compared between the two groups.Results Compared with the control group,the treatment group showed that the respiratory frequency was significantly reduced,tidal volume （VT） was increased （t =3.998,P〈 0.05）,inspiratory resistance （IR） was decreased （t=3.902,P〈0.05）,static compliance （C stat） was increased （t=4.487,P〈0.05）,patient work of breathing （WOBt） and imposed work of breathing （WOBimp） and pressure-time product were decreased （t=4.951 and 4.842,both P〈0.01）; and showed declined plateau pressure （Pplat） （t=2.078,P〉0.05）,peak airway pressure （Ppeak） （t=1.504,P〉0.05） and inspiratory resistance （IR） （t=3.902,P〈0.05）,increased static compliance （Cstat） （t=4.487,P〈0.05）.There were no significant differences in the arterial oxygen partial pressure,oxygenation index and carbon dioxide partial pressure （t =2.099,1.894,2.487,respectively,all P〉0.05）.Conclusions Compared with conventional SIMV,the adaptive support ventilation support could enhance tidal volume,reduce respiratory rate and respiratory muscle work,increase man-machine harmonization,and shorten the duration of mechanical ventilation.