容积保证压力支持通气中应用不同水平恒定供气流量对呼吸衰竭患者肺力学参数的影响

Effect of Different Levels of Constant Air Supply Flow in Volume-Guaranteed Pressure-Supported Ventilation on Pulmonary Mechanical Parameters in Patients with Respiratory Failure

目的探讨容积保证压力支持(VAPS)通气中应用不同水平恒定供气流量(CF)对呼吸衰竭患者肺力学参数的影响作用。方法选取2018年1月至2019年1月南京医科大学附属淮安第一医院收治的24例呼吸衰竭患者,均接受机械通气支持超过24 h,患者保持镇静的状态。先使用定容型通气模式(VCV),潮气量(VT)为7~9 mL/kg,接着转变为容积保证压力支持通气,吸气压为定容型通气模式时的Pplat,供气流量分别为10 L/min、15 L/min,最后给予压力支持通气(PSV);急性肺损伤患者在VAPS时的PIF增高最显著,CF为10 L/min时PIP-Pplat降至(1.1±0.4)cmH2O,此时CF/PIF为(23.4±1.1)%。结果吸入沙丁胺醇后,切换至VAPS通气后,吸气峰值流速(PIF)均显著增高,而吸气峰压力(PIP)却降低。结论容积保证压力支持通气为新的闭环控制机械通气技术,可减少患者呼吸做功,降低气道峰压。

Objective To investigate the effect of different levels of constant air supply flow(CF)on pulmonary mechanical parameters in patients with respiratory failure during volume-guaranteed pressure support(VAPS)ventilation.Methods Totally 24 patients with respiratory failure admitted to Huai'an First Hospital Affiliated to Nanjing Medical University from January 2018 to January 2019 were enrolled.All of the patients received mechanical ventilation support for more than 24 h.The patient remained sedated.The constant volume ventilation mode(VCV)was first used,with tidal volume(VT)of 7~9 mL/kg,followed by the conversion to VAPS.The suction pressure was the Pplat in the constant volume ventilation mode,and the air supply flow was 10 L/min^15 L/min,and finally pressure support ventilation(PSV)was given.Results After inhalation of salbutamol,PIF was significantly increased after switching to VAPS ventilation,while PIP was decreased.Patients with acute lung injury had the most significant increase in PIF at VAPS.When the CF was 10 L/min,the PIP-Pplat decreased to(1.1±0.4)cmH2O,and the CF/PIF was(23.4±1.1)%.Conclusion VAPS was a new closed-loop controlled mechanical ventilation technology that can reduce patient breathing work and reduce airway peak pressure.