老年慢性阻塞性肺疾病并呼吸衰竭患者应用适应性支持通气在撤机中的作用

Clinical efficiency of adaptive support ventilation on withdrawing from ventilatory support during weaning in elderly COPD patients with respiratory failure

目的探讨适应性支持通气（ASV）在老年慢性阻塞性肺疾病（C（）PD）并呼吸衰竭患者撤机中应用的临床意义。方法选择老年慢性阻塞性肺疾病急性加重期（AECOPD）并呼吸衰竭需机械通气患者60例，将其随机分为两组，每组30例，治疗组患者接受ASV，对照组选用同步间歇指令＋斥力支持通气（SIMV＋PSV），比较两组患者撤机过程中的呼吸力学指标、血气分析参数变化，以及总通气时间、呼吸机报警次数、监护室停留时间及窒息通气次数。结果与对照组比较，治疗组患者呼吸频率明显下降，内源性呼气末正压（PEEPi）、吸气阻力均明显下降（t=4．200、4．731、3．562，P=0．032、0．000、0．015），气道闭合压（P0.1）和静态顺应性增加（t=4．064、4．051，P=0．000、0．0227；治疗组呼吸附加功和吸气压力时间乘积均低于对照组（t=3．181、4．836，P=0．046、0．021）。治疗组通气时间、监护室停留时间、呼吸机报警次数和窒息通气次数分别为（93．1±9．28）h、（11．9±1．15）d、（4．3±0．5）次和（3．2±0．2）次，均低于对照组（117．6±10．05）h、（18．2±1．66）d、（8.2±0.7）次和（5．3±0．4）次（t=3．878、3．776、3．195、3．743，P=0．022、0．046、0．000、0．018）。结论ASV可降低呼吸频率、PEEPi和吸气阻力，使呼吸肌做功减少并缩短老年COPD并呼吸衰竭患者的通气时间。

Objective To investigate the clinical efficiency of adaptive support ventilation on withdrawing from ventilatory support during weaning in elderly COPD patients with respiratory failure. Methods 60 cases with acute exacerbation of chronic obstructive pumonary disease （AECOPD） complicating respiratory failure who needed ASV were randomized into two groups （n=30, each）. The treatment group was assigned to adaptive support ventilation （ASV）, while the control group were assigned to synchronized intermittent mandatory ventilation plus pressure support ventilation （SIMV ＋ PSV） . The respiratory mechanics indices, meanwhile oxygen dynamic parameters, weaning time, ventilator alarms, and manual ventilator settings manipulations were recorded and compared between the two groups. Results The respiratory rate （RR）, intrinsic positive end-expiratory pressure （PEEPi） and inspiratory resistance （RI） were decreased in treatment group as compared with the control group （ t=4. 200, 4. 731, 3. 562, P=0. 032, 0. 000 and 0. 015, respectively）. The airway occlusion pressure at 0.1 s （P0.1） and static compliance （Cstat） were increased in treatment group as compared with control group （t= 4. 064 and 4. 051, P： 0. 000 and 0. 022）. The imposed work of breathing （WOBimp） and inspiratory pressure-time product （PTP） were lower in treatment group than in control group （t=3. 181 and 4. 836, P=0.046 and 0.021）. The weaning time （WT）, duration of ICU stay （DI）, ventilator alarm （VA）, apnea ventilation time （AT） were lower in treatment group than in control group [（93.1±9. 28） h vs. （117.6±10.05） h,（11.9±1.15） d vs. （18.2±1.66） d, （4.3±0.5） times vs. （8.2±0.7） times, （3.2±0.2） times vs. （5.3± 0.4） times, t= 3. 878, 3. 776, 3. 195, 3. 743, respectively, P= 0.022, 0.046, 0.000, 0. 0181. Conclusions Adaptive support ventilation could reduce the respiratory rate, PEEPi and inspiratory resistance, which could decrease the respiratory muscle work and shorten the duration of mechanical ventilation in elderly COPD patients with respiratory failure.