适应性支持通气在心脏瓣膜置换术后患者快通道脱机中的应用

The Study of Fast-track Extubation on Adaptive Support Ventilation for the Patients after Cardiac Valve Replacement

目的:通过比较ASV(适应性支持通气)和SIMV-PSV(同步间歇指令通气-压力支持通气)模式在体外循环心脏瓣膜置换术后患者快通道脱机中的研究,从而为非复杂心脏外科手术后患者寻找一个更加合适的脱机模式。方法:选取我院2007年1月-2013年12月期间体外循环下行心脏瓣膜置换手术患者(二尖瓣置换术或主动脉瓣置换术)纳入研究。体外循环心脏瓣膜置换术后患者常规转入ICU,使用随机数字表随机分为2组,ASV组和SIMV-PSV组,分别给予ASV和SIMV-PSV两种通气模式,并按标准程序脱机。术后比较两组患者血流动力学指标、呼吸力学指标、机械通气时间、快通道的成功率。结果:共53例患者入选该研究(ASV组26例,SIMV-PSV组27例)。ASV组与SIMV-PSV组相比,血流动力学以及血气分析结果相比无统计学差异。呼吸力学指标:ASV组与SIMV-PSV组相比,第一阶段的平均气道内压力[(7.3±1.3)cmH2O VS(10.6±1.5)cmH2O],肺组织动态顺应性[(70.6±13.2)ml/cmH2O VS(50.7±10.3)ml/cmH2O],P0.1[(1.7±0.3)cmH2O VS(3.5±0.8)cmH2O]两组相比具有统计学差异。机械通气时间明显缩短[(205.8±85.6)min VS(328.2±91.0)min];快通道成功率明显增高(84.6%VS 55.6%)。结论:ASV模式能改善呼吸力学指标,减少机械通气时间,增加快通道的成功率,ASV模式为心脏术后的一个安全而理想的脱机模式。

Objective ：By comparing ASV （adaptive support ventilation ） and SIM V-PSV （synchronized intermittent mandatory ventilation and pressure support ventilation ） in patients after valve replacement under cardiopulmonary bypass in fast-track extubation ,we explore a more suitable weaning mode for patients of uncomplicated cardiac surgery . Methods ：The patients after cardiac valve replacement （mitral valve or aortic valve replacement ） from January 2007 to December 2013 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 to the standard procedure ,the patients were extubated .Hemodynamics ,condition of breathing mechanics duration of mechanical ventilation and successful rate of fast-track extubation before extubation was compared .Results：53 patients including 26 patients in ASV group and 27 patients in SIMV-PSV group completed the study .Hemodynamics and blood gas analysis were not significantly different .Condition of breathing mechanics in ASV group was respectively the mean airway pressure in ASV group [（7 .3 ± 1 .3）cmH2 O VS （10 .6 ± 1 .5）cmH2 O] ,Pulmonary dynamic compliance[（70 .6 ± 13.2）ml/cmH2O VS （50 .7±10 .3）ml/cmH2O],P0.1[（1 .7±0 .3）cmH2O VS （3 .5±0 .8）cmH2O]compared with that in SIMV-PSV group （P〈 0 .05） .Parameter in ASV group was respectively successful rate of fast-track extubation （84.6% VS 55 .6% ） ,the duration of mechanical ventilation [（205 .8 ± 85 .6）min VS （328 .2 ± 91 .0）min]compared with that in SIMV-PSV group （P〈0 .05） .Conclusion：ASV mode could improve the parameters of respiratory mechanics , reduce duration of mechanical ventilation ,and accelerate successful rate of fast-track extubation .ASV mode is very safe and effective weaning mode in patients after valve replacement .