无创呼吸机ST模式和AVAPS模式治疗呼吸衰竭的效果比较

Comparison of the effect of non-invasive ventilator ST mode and AVAPS mode in patients with respiratory failure

目的比较平均容积保证压力支持(average volume assured pressure suppont,AVAPS)模式和自主呼吸和时间控制(spontaneous breathing and time control,ST)模式治疗呼吸衰竭的效果。方法回顾性分析2014年10月至2016年10月本院63例呼吸衰竭患者的治疗效果,在治疗过程中有3例患者脱落,将纳入分析的60例患者按照随机数表法均分为研究组和对照组,研究组患者采用AVAPS模式治疗,对照组患者采用ST模式治疗。比较两组患者组间及组内治疗前和治疗后24小时及4天的动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_2)、动脉血氧分压(arterial partial pressure of oxygen,PaO_2)、动脉血pH及实际碳酸氢盐(actual bicarbonate,AB)水平。比较两组患者组间及组内治疗前与治疗后4小时的呼吸频率、心率、第一秒用力呼气量(forced expiratory volume in first second,FEV1)、FEV1占用力肺活量(forced vital capacity,FVC)百分比(FEV1/FVC)及FEV1占预计值百分比(FEV1%预计值)。比较两组患者治疗后4天不良反应的发生情况。结果两组患者治疗后的PaCO_2、PaO_2、动脉血pH及AB水平比较差异均无显著性(P>0.05)。两组患者治疗后24小时、4天的PaCO_2、PaO_2较本组治疗前有显著改善(P<0.05);两组患者治疗后24小时和4天的AB水平、动脉血pH与本组治疗前比较差异均无显著性(P>0.05)。两组患者治疗后4天的呼吸频率和心率均明显低于治疗前(P<0.05)。两组患者治疗后4天的FEV1、FEV1/FVC、FEV1%预计值均明显高于治疗前(P<0.05)。研究组患者治疗后4天不良反应发生率明显低于对照组(P<0.05)。结论 AVAPS模式治疗呼吸衰竭的效果优于ST模式,患者不良反应发生较少,安全可靠。

Objective To compare the effect of average volume assured pressure suppont （AVAPS） mode and spontaneous breathing and time control （ST） mode in the treatment of patients with respiratory failure. Method Retrospectively analyzed the therapeutic effects of 63 patients with respiratory failure from October 2014 to October 2016, 3 patients were excluded during the course of treatment, and 60 patients included in the analysis were randomly divided into study group and control group. Study group patients were treated with AVAPS mode, control group patients were treated with ST mode. Before treatment and 24 hours and 4 days after treatment, the arterial partial pressure of carbon （PaCO2）, arterial partial pressure of oxygen （PaO2）, actual bicarbonate （AB） level were compared between the two groups. Before treatment and 4 days after treatment, respiratory rate, heart rate, forced expiratory volume in first second （FEV1）, FEV1/forced vital capacity （FVC） and FEV1% prediction were compared between the two groups. The incidence of adverse reaction were compared between the two groups 4 days after treatment. Result PaCO2, PaO2, arterial blood pH and AB level were not significantly different between the two groups （P 〉 0.05）. PaCO2 and PaO2 were significantly improved （P 〈 0.05） and arterial blood pH and AB level were not significantly improved 24 hours and 4 days after treatment inside each group （P 〉 0.05）. The respiratory rate and heart rate of the two groups were significantly lower than before treatment （P 〈 0.05）. The FEV1, FEV1/FVC and FEV1% prediction of the two groups were significantly higher than before treatment （P 〈 0.05）. The incidence rates of adverse reaction of study group were significantly lower than control group 4 days after treatment （P 〈 0.05）. Conclusion AVAPS mode is better than ST mode in the treatment of respiratory failure, fewer adverse reactions makes it safe and reliable.