成比例压力支持参数设置方法对AECOPD困难脱机患者脱机效果的影响

A clinical study on the wean effect of setting parameters of proportional pressure support on acute exacerbation of chronic obstructive pulmonary disease patients with difficult weaning

目的探讨目标潮气量法设置成比例压力支持(PPS)参数的临床效应。方法回顾性纳入天津市第三中心医院2016年1月至2020年12月期间收入的慢性阻塞性肺疾病急性加重(AECOPD)患者,根据PPS参数设置方法将患者分为气道阻断法组和目标潮气量组。收集两组患者的基础特征、流量辅助(FA)和容量辅助(VA)的初始设置值、呼吸系统机械参数、临床结局,比较两组上述指标的差异。结果共纳入59例患者,其中气道阻断法组29例,目标潮气量组30例。两组患者基线特征和顺应性、气道阻力、FA、VA的初始设置值比较差异均无统计学意义。PPS参数初始设置后1 h记录的气道阻断法组患者呼吸频率(RR)、平均动脉压(MAP)、潮气量、动脉血氧分压(PaO2)均明显低于目标潮气量组〔RR(次/min):21.0(18.5,22.5)比23.0(21.0,25.0),MAP(mmHg,1 mmHg=0.133 kPa):84.0(79.0,90.5)比90.0(87.0,96.2),潮气量(mL):305.24±41.07比330.87±46.84,PaO2(mmHg):68.0(66.0,73.5)比74.0(69.8,82.5),均P<0.05〕;气道阻断法组患者动脉血二氧化碳分压(PaCO2)、口腔闭合压(P0.1)均明显高于目标潮气量组〔PaCO2(mmHg):41.0(39.0,46.0)比37.5(35.0,42.2),P0.1(cmH2O,1 cmH2O=0.098 kPa):1.42±0.78比0.90±0.67,均P<0.05〕。与气道阻断法组比较,目标潮气量组患者脱机持续时间、ICU住院时间、总住院时间均明显缩短〔脱机持续时间(h):42.0(24.0,70.5)比64.0(30.5,97.5),ICU住院时间:10.00±3.38比13.28±5.41,总住院时间(d):12.07±3.40比15.41±5.60,均P<0.05〕。两组患者的有创机械通气时间、脱机失败率、ICU病死率及院内病死率差异无统计学意义。结论采用目标潮气量法设置PPS参数具有实用、安全、方便、快捷的优点,并缩短了脱机持续时间及ICU住院时间,具有较好的临床应用前景。

Objective To investigate the clinical effect of setting proportional pressure support(PPS)parameters by target tidal volume(VT)method.Methods The study was conducted retrospectively on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients admitted to Tianjin Third Central Hospital from January 2016 to December 2020.According to the PPS parameter setting method,the patients were divided into the airway blocking group and target VT group.The baseline characteristics,initial setting values of flow assist(FA)and volume assist(VA),respiratory system parameters,and clinical outcomes were collected and compared between the two groups.Results Fifty-nine patients were enrolled,29 patients in the airway blocking group,and 30 in the target VT group.There was no statistically significant difference in baseline characteristics,compliance,resistance,and initial settings of FA and VA between the two groups.Compared with the target VT group,the respiratory rate(RR),mean arterial pressure(MAP),VT,and arterial partial pressure of oxygen(PaO2)recorded 1 hour after the initial setting of the PPS parameters in the airway block method group were significantly reduced[RR(times/minute):21.0(18.5,22.5)vs.23.0(21.0,25.0),MAP(mmHg,1 mmHg=0.133 kPa):84.0(79.0,90.5)vs.90.0(87.0,96.2),VT(mL):305.24±41.07 vs.330.87±46.84,PaO2(mmHg):68.0(66.0,73.5)vs.74.0(69.8,82.5),all P<0.05],while arterial partial pressure of carbon dioxide(PaCO2)and oral closure pressure(P0.1)were both increased significantly[PaCO2(mmHg):41.0(39.0,46.0)vs.37.5(35.0,42.2),P0.1(cmH2O,1 cmH2O=0.098 kPa):1.42±0.78 vs.0.90±0.67,both P<0.05].Compared with airway blocking group,the duration of weaning,ICU stay,and hospital stay in the target VT group were significantly shorter[duration of weaning(hours):42.0(24.0,70.5)vs.64.0(30.5,97.5),ICU stay:10.00±3.38 to 13.28±5.41,hospital stay(days):12.07±3.40 vs.15.41±5.60,all P<0.05].There was no statistically significant difference in the invasive mechanical ventilation time,weaning failure rate,ICU mortality and in-hospital mortality between the two groups.Conclusion This study suggested that the target TV method has the advantages of practicality,safety,convenience,and rapid to set PPS parameters than the airway block method,which shortens the duration of weaning and ICU stay,and has a good clinical prospect.