平均容积保证压力支持无创呼吸机通气模式在年龄>60岁慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者中的应用

Application of Non-invasive Ventilator Ventilation Mode with Guaranteed Average Volume Assured Pressure Support in Patients with Chronic Obstructive Pulmonary Disease over 60 Years Old and TypeⅡ Respiratory Failure

目的分析平均容积保证压力支持(AVAPS)无创呼吸机通气模式治疗年龄>60岁慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的价值。方法选取2018年11月至2020年10月许昌市立医院收治的142例COPD合并Ⅱ型呼吸衰竭患者为研究对象,根据无创呼吸机通气模式分为两组,观察组71例选择AVAPS模式,对照组71例选择自主呼吸及时间控制通气(ST)模式。比较两组通气前及通气后1、24 h动脉血气指标[氧合指数(PaO_(2)/FiO_(2))、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]和生命体征指标[平均动脉压(MAP)、心率(HR)],通气后1 h及24 h通气参数(潮气量、通气量、气道峰压),以及并发症发生情况。结果通气后1、24 h,两组PaO_(2)/FiO_(2)、PaO_(2)均高于通气前,PaCO_(2)低于通气前(P<0.05);通气后1、24 h,两组MAP、HR均低于通气前(P<0.05);观察组通气后1 h潮气量、通气量、气道峰压及通气后24 h潮气量高于对照组(P<0.05);观察组胸闷憋气、胃胀气、气管插管发生率低于对照组(P<0.05)。结论AVAPS无创呼吸机通气模式治疗年龄>60岁COPD并Ⅱ型呼吸衰竭患者,可改善血气指标及生命体征指标,减少并发症,对改善预后有积极作用。

Objective To analyze the value of average volume assured pressure support(AVAPS)non-invasive ventilator ventilation mode in the treatment of patients with chronic obstructive pulmonary disease(COPD)over 60 years old and typeⅡ respiratory failure.Methods A total of 142 patients with COPD and typeⅡ respiratory failure in Xuchang Municipal Hospital from November 2018 to October 2020 were selected and divided into 2 groups according to the different ventilation modes of non-invasive ventilator.A total of 71 cases in observation group chose AVAPS mode,and 71 cases in control group chose spontaneous breathing and time-controlled ventilation(ST)mode.The arterial blood gas indexes[oxygenation index(PaO_(2)/FiO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))]and vital signs[mean arterial pressure(MAP),heart rate(HR)]before ventilation and 1 hour,24 hours after ventilation of the two groups,ventilation parameters(tidal volume,ventilation volume,peak airway pressure)1 hour and 24 hours after ventilation,and complications were compared in the two groups.Results PaO_(2)/FiO_(2) and PaO_(2) in the two groups were higher than those before ventilation at 1 hour and 24 hours after ventilation,and PaCO_(2) was lower than that before ventilation(P<0.05).MAP and HR in the two groups at 1 hour and 24 hours were lower than those before ventilation(P<0.05).The observation group’s tidal volume,ventilation volume,peak airway pressure and 24-hour tidal volume after ventilation were higher than those in control group(P<0.05).The incidences of chest tightness,suffocation flatulence and tracheal intubation were lower in observation group than those in control group(P<0.05).Conclusion AVAPS non-invasive ventilator ventilation mode can treat patients with COPD and typeⅡ respiratory failure who are older than 60 years old.It can improve blood gas and vital signs,reduce complications,and have a positive effect on improving the prognosis.