适应性支持通气在急性呼吸窘迫综合征中的应用研究

Application of adaptive support ventilation in mechanical ventilation patients with acute respiratory distress syndrome

目的探讨适应性支持通气模式(ASV)和压力控制同步间歇指令通气模式(P-SIMV)在急性呼吸窘迫综合征(ARDS)患者中的差异。方法选择符合ARDS最新诊断标准的患者,排除了部分不符合实验条件的患者,随机分为两组,一组应用ASV模式,另一组运用P-SIMV模式,设置相应的参数。各组均进行标准化治疗。最后比较两组患者通气48小时后与上机时的RR、潮气量、p H值、PO2、PCO2、SO2、氧合指数,以及累积机械通气时间和ICU住院天数的差异。结果两组共入选60例患者,对比发现ASV组通气48h后的RR、p H值、PO2、PCO2、SO2、氧合指数均较上机时有统计学意义(P<0.05)。P-SIMV组通气48h后的RR、潮气量、PO2、SO2、氧合指数较上机时有统计学意义(P<0.05)。ASV组患者通气48h后的p H值、PCO2、氧合指数,以及累积机械通气时间和ICU住院天数较P-SIMV组具有统计学意义(P<0.05)。结论对于ARDS患者,ASV模式较P-SIMV模式能够缩短呼吸机使用时间以及入住ICU的天数,ASV模式可作为推荐模式之一。

Objective To investigate the differences between adaptive support ventilation （ASV） and pres-sure control synchronous intermittent mandatory ventilation （P-SIMV） in patients with acute respiratory distress syn-drome （ARDS）. Methods Patients with ARDS were selected and randomly divided into two groups, one treated with ASV mode and the other with P-SIMV mode. Both groups treated with standardized treatment. Finally, the differences of RR, tidal volume, pH value, P02, PC02, S02, oxygenation index, cumulative mechanical ventilation time and ICU hospital stay were compared between the two groups 48 hours after ventilation. Results 48 hours after mechanical ventilation treatment, the RR, pH value, P02, PC02, S02 and oxygenation indexes in the two groups were significantly higher than those before treatment （ P 〈0. 05）. The pH value, PC02, oxygenation index, cumula-tive mechanical ventilation time and ICU hospital stay were better in the ASV group than in the P-SIMV group （P 〈 0.05）. Conclusion ASV mode can be used as one of the recommended models for ARDS patients, because the ASV mode can shorten the time of ventilator deployment and reduce the residence time in ICU.