压力调节容量控制通气与同步间歇指令通气治疗老年慢性阻塞性肺疾病并呼吸衰竭的疗效比较

The Curative Effect Comparison of Pressure Regulated Volume Control Ventilation and Synchronized Intermittent Mandatory Ventilation in the Treatment of Elderly Patients with Chronic Obstructive Pulmonary Disease and Respiratory Failure

目的比较压力调节容量控制通气(PRVC)与同步间歇指令通气(SIMV)治疗老年慢性阻塞性肺疾病(COPD)并呼吸衰竭的临床疗效。方法选取2010年8月至2014年2月荆州市传染病医院住院治疗的77例老年COPD并呼吸衰竭患者,根据随机数字表法分为PRVC组(40例)和SIMV组(37例),比较两组临床疗效,治疗前后血气分析指标,治疗后呼吸力学指标及并发症。结果PRVC组治疗总有效率(87.5%)显著高于SIMV组(73.0%)(P<0.05);PRVC组患者治疗后动脉血氧分压明显高于治疗前及SIMV组治疗后(P<0.05或P<0.01),PRVC组患者治疗后动脉血二氧化碳分压[(130±12)mm Hg(1 mm Hg=0.133 k Pa)]显著低于治疗前[(117±11)mm Hg,P<0.05]及SIMV组治疗后[(122±12)mm Hg,P<0.01];PRVC组患者治疗4 h、2 d后气道峰压[(27±8)cm H2O,(23±7)cm H2O]均显著低于SIMV组[(36±9)cm H2O,(33±10)cm H2O,P<0.01],PRVC组和SIMV组患者治疗2 d后每分钟通气量[(6.07±1.54)L/min,(6.37±1.74)L/min]和平均动脉压[(9.3±3.3)cm H2O,(9.7±3.6)cm H2O]均明显低于治疗4 h后[(7.95±2.23)L/min,(8.01±2.20)L/min;(12.9±3.3)cm H2O,(13.1±3.2)cm H2O,P<0.01],但同时间点两组间比较差异无统计学意义(P>0.05);PRVC组患者并发症发生率(10.0%)显著低于SIMV组(24.3%)(P<0.05)。结论 PRVC治疗老年COPD并呼吸衰竭患者疗效显著,可明显改善血气分析指标和气道峰压,降低并发症发生率。

Objective To compare the curative effect of pressure regulated volume control ventilation （PRVC） and synchronized intermittent mandatory ventilation （ SIMV） in the treatment of elderly patients with chronic obstructive pulmonary disease（ COPD） and respiratory failure.Methods A total of 77 elderly patients with COPD and respiratory failure hospitalized in Jingzhou City Infectious Diseases Hospital from Aug.2010 to Feb.2014 were divided into PRVC group（n=40） and SIMV group（n=37） according to ran-dom-number table method.The clinical curative effect,blood gas index,respiratory mechanics and complica-tions after treatment of the two groups were compared.Results The total effective rate of PRVC group （87.5%） was significantly higher than that of SIMV group（73.0%）（P〈0.05 or P〈0.01）,and the PaO2 of PRVC group after treatment was significantly higher than before treatment and SIMV group after treatment （P〈0.05）.The PaCO2 of PRVC group after treatment[（130 ±12） mmHg] was significantly lower than before treatment[（117 ±11） mmHg,P〈0.05]and SIMV group after treatment[（122 ±12） mmHg,P 〈0.01];the peak airway pressure of PRVC group 4 h,2 d after treatment[（27 ±8） cmH2O,（23 ± 7） cmH2O] were significantly lower than that of SIMV group[（36 ±9） cmH2O,（33 ±10） cmH2O,P 〈0.01],the minute ventilation [（6.07 ±1.54） L/min,（6.37 ±1.74） L/min] and mean arterial pressure [（9.3 ±3.3） cmH2O,（9.7 ±3.6） cmH2O] of PRVC group and SIMV group 2 d after treatment were sig-nificantly lower than those of 4 h after treatment[（7.95 ±2.23） L/min,（8.01 ±2.20） L/min;（12.9 ± 3.3） cmH2O,（13.1 ±3.2） cmH2O,P 〈0.01],but there was no significant difference at the same time point（P〉0.05）.The complications incidence of PRVC group（10.0%） was significantly lower than that of SIMV group（24.3%）（P 〈0.05）.Conclusion The treatment of PRVC for elderly COPD patients with respiratory failure has a remarkable curative effect,which can obviously improve the blood gas analysis index and peak airway pressure,and reduce the incidence of complications.