老年重症肺炎患者适应性支持通气模式机械通气治疗的临床分析

Clinical analysis of adaptive support ventilation and mechanical ventilation in elderly patients with severe pneumonia

目的:研究适应性支持通气模式(ASV)对老年重症肺炎机械通气患者呼吸力学参数的影响。方法:选择60例老年重症肺炎并且行机械通气的患者,按照随机数字表法,分为观察组和对照组,每组30例。对照组采用同步间歇指令通气+压力支持通气+呼气末正压通气(SIMV+PSV+PEEP)联合模式通气,观察组采用ASV模式通气。比较2组患者呼吸力学参数、血液动力学、血气分析的差异。结果:观察组的气道峰压(Ppeak)、平均气道压(Pmean)、吸气阻力(Rins)、呼吸频率(RR)分别为(25. 34±2. 25) mmHg、(14. 32±1. 78) mmHg、(13. 15±4. 52) cm H_2O/(L·s)、(20. 75±4. 37)次/min,较对照组明显降低(均P <0. 05)。观察组的每搏排出量(SV)、心排量(CO)分别为(81. 94±17. 34) mL、(4. 11±1. 32) L/min,较对照组明显升高(均P <0. 05)。结论:老年重症肺炎患者采用AVS模式机械通气可显著改善患者呼吸力学参数、血液动力学、血氧饱和度状况,较SIMV+PSV+PEEP联合模式疗效更佳,值得推广应用。

Objective： To study the effect of adaptive support ventilation（ ASV） on respiratory mechanics parameters in elderly patients with severe pneumonia and mechanical ventilation. Methods： Sixty cases of severe pneumonia in the intensive care unit of Department of Respiration from June 2014 to June 2016 were selected and the patients with mechanical ventilation were studied. According to the random number table method,the patients were randomly divided into observation group and control group. The control group was ventilated by SIMV ＋ PSV ＋ PEEP combined mode,and the observation group was ventilated by ASV mode. The effects of two models on respiratory mechanics parameters,hemodynamics and blood gas analysis were investigated. Results： In the observation group,the peak airway pressure（ Ppeak）,mean airway pressure（ Pmean）,inspiratory resistance（ Rins） and respiratory rate（ RR） were（ 25. 34 ± 2. 25） mm Hg,（ 14. 32 ± 1. 78） mm Hg,（ 13. 15 ±4. 52） cm H2O/（ L,S） and（ 20. 75 ± 4. 37）/min respectively,which were decreased significantly as compared with the control group（ P〈0. 05）. The rate of per stroke（ SV） and cardiac output（ CO） were（ 81. 94 ± 17. 34） mL and（ 4. 11 ±1. 32） L/min respectively in the observation group,which were significantly higher than those in the control group（ P〈0. 05）. Conclusion： The combination of AVS mode and SIMV ＋ PSV ＋ PEEP mode can significantly improve respiratory mechanics parameters,hemodynamics and blood oxygen saturation in elderly patients with severe pneumonia,and is worthy of wide application.