ASV模式机械通气治疗重症哮喘的临床研究

Clinical study of ASV mode mechanical ventilation in the treatment of severe asthma

目的研究不同通气模式对重症哮喘患者的疗效。方法我院2011至2014收治的重症哮喘患者60人,随机分为A、B两组,分别给予同步间歇指令通气+压力支持通气(SIMV+PSV)及适应性支持通气(ASV),每组30人。比较两组患者呼吸力学指标,血气以及血清炎症因子水平。结果与SIMV+PSV组相比,ASV组的潮气量(VT)明显升高(P<0.01),呼吸频率(RR)(P<0.01)、气道峰压(Ppeak)(P<0.05)、气道阻力(R)(P<0.05)明显降低;ASV组的C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)均明显低于SIMV+PSV组(P<0.01)。ASV组患者上机时间明显缩短(P<0.05)。结论ASV通气模式有利于降低重症哮喘患者的机体炎症反应,减少呼吸功并改善高通气力学,减少通气时间。

Objective To investigate the effect of different modes of mechanical ventilation on patients with severe asthma. Methods 60 patients with severe asthma were randomly divided into two groups, 30 cases in each group. The group A was treated with synchronized intermittent mandatory ventilation （SIMV） plus pressure support ventilation （PSV）, and the group B was treated with SIMV plus adaptive support ventilation （ASV）. Their respirato- ry mechanics, blood gas and serum inflammatory factors were compared. Results Compared with the PAV group, the tidal volume （VT） increased significantly （P 〈 0. 01 ）, and their respiratory rate （ RR）, peak inspiratory pres- sure （PIP） and inspiratory resistance （R） decreased significantly in the ASV group （P 〈0. 01 or P 〈0. 05）. The levels of C-reactive protein, procaleitonin （PCT）, interleukin- 6 （IL-6） and tumor necrosis factor-or （TNF-α） were obviously lower in the ASV group than in the PSV group （P 〈 0. 01 ）, and the time of mechanical ventilation was sig- nificantly shorter in the ASV group than in the PSV group （P 〈 0. 05）. Conclusion ASV can reduce the inflamma- tory reaction and the work of breathing, improve high ventilation mechanics and shorten ventilation time in the treat- ment of severe asthma.