SIMV、PSV及A/C模式对呼吸机相关性膈肌功能障碍影响对比

Comparison of the effects of SIMV,PSV and A/C modes on ventilator-related diaphragmatic dysfunction

目的:探究同步间隙指令通气(SIMV)、压力支持通气(PSV)和辅助/控制通气(A/C)3种模式对呼吸机相关性膈肌功能障碍的影响,以提高呼吸机脱机成功率。方法:选取医院收治的54例接受动脉取栓并在重症监护室中接受无创机械通气≥24 h的患者,根据随机数表法将其分为SIMV组、A/C组和PSV组,每组18例,并给予相应机械通气模式。比较3组机械通气期间的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)、氧合指数(PaO2/FiO2)、酸碱度(pH值)、血二氧化碳分压(PaCO2)、血红蛋白(Hb)和血清白蛋白(ALB)含量的检查指标,以及机械通气时间、脱机成功率、48 h重新插管率、重症监护室滞留时间及住院生存率。通过单因素分析和多因素Logistic回归分析探究影响脱机成功的因素。结果:SIMV组和PSV组机械通气时间和重症监护室滞留时间低于A/C组,差异有统计学意义(tSIMV组=5.146,t=6.238;tPSV组=7.718,t=5.353;P<0.05);SIMV组和PSV组48 h重新插管率低于A/C组,脱机成功率高于A/C组,差异有统计学意义(xSIMV组2=3.200,x^2=5.806;xPSV组2=3.200,x^2=3.200;P<0.05)。影响脱机成功的单因素分析中,脱机成功患者急性生理与慢性健康评分-Ⅱ(APACHE-Ⅱ)高于脱机失败患者(t=3.965,P<0.05),SIMV和PSV通气模式脱机成功患者的比例均高于A/C通气模式(xSIMV2=3.200,xPSV2=5.806;P<0.05)。经多因素Logistic回归分析,APACHE-Ⅱ高是影响脱机成功的危险因素,SIMV和PSV模式是影响脱机成功的保护因素(ORAPACHE-Ⅱ=0.698,ORSIMV=4.426,ORPSV=7.927;P<0.05)。结论:SIMV和PSV模式与A/C模式相比对患者机械通气过程中的膈肌功能影响更小,脱机成功率更高,具有良好的临床应用价值。

Objective:To explore the effects of synchronized intermittent mandatory ventilation(SIMV),pressure support ventilation(PSV)and assisted/controlled ventilation(A/C)on ventilator-related diaphragmatic dysfunction,so as to improve the success rate of weaning of ventilator.Methods:54 patients who received arterial thrombectomy and whose time of non-invasive mechanical ventilation in intensive care unit(ICU)were larger than or equal to 24 h were selected.And they were divided into SIMV group(18 cases),A/C group(18 cases)and PSV group(18 cases)according to random number table,and all of them received the mode of corresponding mechanical ventilation.The heart rate(HR),mean artery pressure(MAP),arterial oxygen saturation(SpO2),the percentage of PaO2 and fraction of inspiration O2(FiO2)(PaO2/FiO2),pH,arterial blood carbon dioxide partial pressure(PaCO2),Hemoglobin(Hb)and blood albumin(Alb)during mechanical ventilation of three groups were compared,and the time of mechanical ventilation,success rate of weaning,re-intubation rate within 48 h,retention time in ICU and survival rate in hospital among the three groups were also compared.The single factor analysis and multivariate Logistic regression analysis were applied to explore the factors that affect the success of weaning.Results:The mechanical ventilation time and the retention time in ICU of SIMV group and PSV group were significantly lower than those of A/C group(tSIMV group=5.146,t=6.238,tPSV group=7.718,t=5.353,P<0.05).The re-intubation rates within 48h of SIMV group and PSV group were significantly lower than that of A/C group,and the success rate of weaning of them were significantly higher than that of A/C group(xSIMV group2=3.200,x2=5.806,xPSV group2=3.200,x2=3.200,P<0.05),respectively.In the single factor analysis,the scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ)in patients with successful weaning were significantly higher than those in patients with failed weaning(t=3.965,P<0.05),and the proportions of patients with successful weaning of SIMV group and PSV group were significantly higher than that of A/C group(xSIMV group2=3.200,xPSV group2=5.806,P<0.05),respectively.By multivariate logistic regression analysis,the high score of APACHE-II was a risk factor that affected the success of weaning,and SIMV mode and PSV mode were the protective factors which affected that(ORAPACH-II=0.698,ORSIMV=4.426,ORPSV=7.927,P<0.05),respectively.Conclusion:Compared with PSV mode and A/C mode,SIMV mode has less influence on diaphragm function during mechanical ventilation on patients,and its success rate of weaning is higher,and it has favorable value in clinical application.