适应性支持通气与自主呼吸试验对撤机患者呼吸力学参数影响

Effect of Adaptive Support Ventilation and Different Spontaneous Respiratory Trials on Quiting Respiratory Mechanics Parameters of Patients

目的通过比较适应性支持通气与自主呼吸试验方法对准备撤机患者呼吸力学参数的影响,指导临床撤机。方法入选32例机械通气的患者,在治疗过程中均达到撤机标准。所有患者先后采用3种方法的呼吸试验即ASV(适应性支持通气)、低水平PSV(7 cm H2O)和T管试验,每次呼吸试验持续20 min,每种呼吸试验结束时,以下通气参数被记录:潮气量(VT)、呼吸频率(RR)、血氧饱和度(Sa O2)、气道闭合压(P0.1)、最大吸气压(Pimax)和呼吸浅快指数(RSBI),比较在采用3种不同方法时各呼吸力学参数的差异。结果 30例患者成功完成了3种呼吸试验,在应用ASV、低水平PSV时,患者的P0.1、Pimax、RSBI和RR与T管比较均明显降低,而VT和Sa O2均增加,ASV组、低水平PSV组各参数与T管组比较差异均有统计学意义(P<0.05),低水平PSV组P0.1、VT与ASV组比较是下降的,而RR是增高的,差异有统计学意义(P<0.05)。结论应用ASV组、低水平PSV进行自主呼吸试验优于T管试验,ASV组更有优势,对临床进行撤机具有一定指导意义。

Objective To investigate the effect of spontaneous breathing trials （SBT） and adaptive support ventilation （ASV） on re-spiratory mechanics parameters to guide to quit the use of mechanics.Methods 32 patients who were ready for weaning were enrolled. All patients underwent three methods：ASV, low level pressure support ventilation （ PSV,7 cm H2 O） and T-piece.Each breathing trials continued for 20min, the respiratory mechanics parameters included： tidal volume（TV）, breathing rate（RR）,blood oxygen saturation （SaO2）,airway occlusion pressure（P0.1）, maximal inspiratory mouth pressure（Pimax） and rapid shallow breathing index（RSBI）were measured before each trial.Their differences between spontaneous breathing trials and ASV were compared .Results 30 patients success-fully completed different breathing methods .Compared with the T-piece,P0.1 ,Pimax,RSBI and RR in the patients using low level PSV and ASV were significantly decreased while VT and SaO 2 increased .The difference of each parameter in the low level PSV group and ASV had statistical significance compared with T -piece group （ P〈0.05 ） .Compared with the low PSV group , P0.1 , VT in ASV group elevated while RR reduced.The difference between two groups were statistically significant （ P〈0.05 ）.Conclusion For ventilation patients in weaning process with spontaneous breathing trial ,low levels of PSV and ASV are better than T -piece,and the ASV group has more advanta-ges.It has certain guiding significance for clinic.