不同闭环通气模式对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者呼吸机撤离价值比较

Comparison values of different closed-loop ventilation modes for chronic obstructive pulmonary disease combined with typeⅡrespiratory failure during withdrawal of ventilator

目的比较指令分钟通气(MMV)和适应性支持通气(ASV)两种闭环通气模式对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者在呼吸机撤离过程中临床价值。方法选择80例接受机械通气的COPD合并Ⅱ型呼吸衰竭患者,其中男性48例,女性32例;年龄53~68岁,平均年龄60.7岁。依据随机原则分为MMV组(予以MMV通气模式)和ASV组(予以ASV通气模式)。MMV组40例,其中男性23例,女性17例;年龄(59.5±7.0)岁。ASV组40例,其中男性25例,女性15例;年龄(62.4±6.8)岁。两组患者经治疗病情稳定后脱机,除脱机时通气模式不同外,其他处理均相同。记录每例患者的脱机时间、总机械通气时间、脱机成功率、脱机耐受率、再插管率和重症监护病房(ICU)住院时间、ICU病死率。应用多元Logistic回归分析评估脱机成功的危险因素。结果与MMV组比较,ASV组脱机成功率和脱机耐受率较高(77.5%vs 65.0%;χ^2=5.515、3.905,P<0.05),脱机时间、总机械通气时间、再插管率较少[(74.2±8.5)h vs(81.2±9.4)h,(6.7±1.1)d vs(7.4±1.6)d,20.0%vs 27.5%;t=3.493、2.280,χ^2=4.121,P<0.05],ICU住院时间、ICU病死率差异无统计学意义(t=1.436、3.765,P>0.05)。多元Logistic回归分析显示,ASV模式的闭环通气模式是COPD合并Ⅱ型呼吸衰竭患者脱机成功率的保护性因素(OR=0.268,P=0.033)。结论COPD合并Ⅱ型呼吸衰竭患者通过ASV进行脱机,能显著提高脱机成功率,缩短脱机时间。

Objective To compare clinical value of mandatory minute ventilation(MMV)and adaptive support ventilation(ASV)closed-loop ventilation mode for chronic obstructive pulmonary disease(COPD)patient combined with typeⅡrespiratory failure during ventilator withdrawal.Methods A total of 80 COPD patients combined with typeⅡrespiratory failure received mechanical ventilation were enrolled,which included 48 males and 32 females,aged 53-68 years old with mean age of 60.7 years old.All of them were randomly divided into MMV group[MMV ventilation mode,n=40,23 males and 17 females;aged(59.5±7.0)years old]and ASV group ASV ventilation mode,n=40,25 males and 15 females;aged(62.4±6.8)years old.The 2 groups withdrawal ventilator in stable condition after treatment,the mode of ventilation withdrawal was different,and other treatments were the same.The withdrawal time,total mechanical ventilation time,withdrawal success rate,withdrawal tolerance rate,reintubation rate,intensive care unit(ICU)time and ICU mortality were recorded.The multivariate Logistic regression analysis was used to assess risk factors for withdrawal success.Results Compared with MMV group,the withdrawal success rate and withdrawal tolerance rate were significantly higher in ASV group(77.5%vs 65.0%;χ^2=5.515,3.905,P<0.05),and the withdrawal time,total mechanical ventilation time,and reintubation rate were less in ASV group[(74.2±8.5)hours vs(81.2±9.4)hours,(6.7±1.1)days vs(7.4±1.6)days,20.0%vs 27.5%;t=3.493,2.280,χ^2=4.121,P<0.05].There were no significant difference between 2 groups in ICU time and ICU mortality(t=1.436,3.765,P>0.05).In multiple Logistic regression analysis,ASV closed-loop ventilation mode was protective factor for success rate of COPD combined with typeⅡrespiratory failure(OR=0.268,P=0.033).Conclusion It is demonstrated that COPD patients with typeⅡrespiratory failure withdrawal ventilation by ASV could significantly increase withdrawal success rate and shorten withdrawal time.