高龄慢性肺源性心脏病并发Ⅱ型呼吸衰竭患者ASV模式治疗的应用价值

Application value of ASV mode therapy in elderly chronic pulmonary heart disease patients complicated with typeⅡrespiratory failure

目的探讨高龄慢性肺源性心脏病并发Ⅱ型呼吸衰竭患者采用适应性支持通气(ASV)模式治疗的应用价值。方法选取该院2014年6月至2017年12月收治的110例高龄慢性肺源性心脏病并发Ⅱ型呼吸衰竭患者作为研究对象,采用随机数字表法分为研究组和对照组,每组55例。研究组采用ASV模式治疗,对照组采用同步间歇指令通气+压力支持通气模式治疗。比较两组治疗前、治疗48 h后的血气分析指标水平;比较两组治疗前、治疗1周后的炎症指标水平;比较两组治疗48 h后的呼吸力学参数水平。结果治疗48 h后,两组的pH值、动脉血氧分压水平较治疗前明显升高,动脉血二氧化碳分压水平较治疗前明显降低,差异均有统计学意义(P<0.05)。治疗1周后,研究组C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-17(IL-17)水平均低于对照组(P<0.05);两组治疗1周后CRP、PCT、TNF-α、IL-17水平均低于治疗前(P<0.05)。治疗48 h后,研究组气道峰压、平均气道压、气道平台压、吸气阻力水平低于对照组,潮气量水平高于对照组,差异均有统计学意义(P<0.05)。结论高龄慢性肺源性心脏病并发Ⅱ型呼吸衰竭患者采用ASV模式进行机械通气治疗能改善患者血气分析指标,减轻机体炎性反应,保护患者肺功能。

Objective To investigate the application value of adaptive support ventilation(ASV)mode in elderly chronic pulmonary heart disease patients complicated with typeⅡrespiratory failure.Methods A total of 110 elderly chronic pulmonary heart disease patients complicated with typeⅡrespiratory failure in the hospital from June 2014 to December 2017 were selected as the research objects,and were randomly divided into study group and control group by random number table,with 55 cases in each group.The study group was treated with ASV mode,and the control group was treated with synchronous intermittent mandatory ventilation+pressure support ventilation mode.Compared the blood gas analysis indexes levels of the two groups before treatment and 48 hours after treatment.Compared the inflammation indexes levels of the two groups before treatment and 1 week after treatment.Compared the respiratory mechanics parameters levels of the two groups after 48 hours of treatment.Results After 48 hours of treatment,the pH value and arterial partial pressure of oxygen level in the two groups were significantly higher than those before treatment,and the arterial partial pressure of carbon dioxide level was significantly lower than that before treatment,the differences were statistically significant(P<0.05).After 1 week of treatment,the levels of C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α)and interleukin-17(IL-17)in the study group were lower than those in the control group(P<0.05).The levels of CRP,PCT,TNF-αand IL-17 in the two groups after 1 week of treatment were lower than those before treatment(P<0.05).After 48 hours of treatment,the peak airway pressure,average airway pressure,airway plateau pressure and inspiratory resistance in the study group were lower than those in the control group,and the tidal volume level was higher than that in the control group,the differences were statistically significant(P<0.05).Conclusion Elderly chronic pulmonary heart disease patients complicated with typeⅡrespiratory failure using ASV mode for mechanical ventilation can improve the blood gas analysis indexes,reduce the body's inflammatory response and protect the lung function of the patient.