适应性支持通气在慢性阻塞性肺疾病并发呼吸衰竭老年患者撤除呼吸机过程中的应用价值

Application value of adaptive support ventilation in respirator removal in elderly patients with chronic obstructive pulmonary disease complicated with respiratory failure

目的探讨适应性支持通气(ASV)在慢性阻塞性肺疾病(COPD)并发呼吸衰竭老年患者呼吸机撤除中的应用价值。方法选择2015年3月至2016年3月郑州大学第二附属医院收治的156例COPD并发Ⅱ型呼吸衰竭老年患者为研究对象,依据机械通气模式分为观察组(89例)和对照组(67例)。对照组患者采用同步间歇指令通气模式,观察组患者采用ASV模式,比较2组患者的呼吸力学指标、呼吸机撤除成功率。结果撤机过程中,观察组患者呼吸频率、内源性呼气末正压、吸气阻力、附加呼吸功、吸气压力时间乘积显著小于对照组,第0.1秒气道闭合压和肺静态顺应性显著大于对照组(P<0.05)。观察组和对照组患者呼吸机撤除成功率分别为92.13%(82/89)、83.58%(56/67);观察组患者呼吸机撤除成功率高于对照组(χ2=4.823,P<0.05)。结论 ASV模式可减少患者呼吸肌自主做功,改善人机协调性,促进自主呼吸功能恢复,提高撤机成功率。

Objective To investigate the application value of adaptive support ventilation(ASV)in respirator removal in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods A total of 156 elderly patients with COPD complicated with typeⅡrespiratory failure in the Second Affiliated Hospital of Zhengzhou University from March 2015 to March 2016 were selected as the research objects.The patients were divided into observation group(n=89)and control group(n=67)according to the mechanical ventilation pattern.The patients in the control group were treated with synchronous intermittent mandatory ventilation pattern,and the patients in the observation group were treated with ASV pattern.The respiratory mechanics index and the success rate of respirator removal were compared between the two groups.Results In the process of respirator removal,the respiratory rate,intrinsic positive end expiratory pressure,inspiratory resistance,work of breathing imposed and pressure-time product in the observation group were significantly lower than those in the control group;and the 0.1 second airway occlusion pressure and static lung compliance in the observation group were significantly more than those in the control group(P<0.05).The successful rate of respirator removal in the observation group and the control group was 92.13%(82/89)and 83.58%(56/67)respectively,and the success rate of the respirator removal in the observation group was higher than that in the control group(χ2=4.823,P<0.05).Conclusion The ASV pattern can reduce the voluntary work of respiratory muscles,improve man-machine coordination,promote the recovery of spontaneous breathing function,and improve the success rate of respirator removal.