无创通气AVAPS模式对慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者的治疗价值

The therapeutic value of non-invasive ventilation with AVAPS mode in COPD patients with typeⅡrespiratory failure

目的分析无创机械通气平均容积保证压力支持(AVAPS)模式对慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者的治疗价值。方法选取2021年1月~2022年12月在北京市房山区良乡医院呼吸科住院的82例慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者,随机数表法分为对照组(n=42)和观察组(n=40)。对照组采用双水平正压通气(BiPAP)S T模式+内科治疗方案,观察组采用AVAPS模式(S T+VT目标)+内科治疗方案。观察两组患者血气指标变化、通气效果和呼吸机相关并发症发生率。结果对照组患者呼吸机不耐受给予内科治疗5例、治疗失败气管插管者8例;观察组40例,呼吸机不耐受2例、治疗失败气管插管者3例,并且插管后进呼吸重症监护室(RICU)治疗,无1人死亡,其余患者全都好转出院。机械通气治疗后,两组患者pH值均上升,二氧化碳分压(PaCO_(2))降低,与机械通气前比较,差异有统计学意义(P<0.05);观察组机械通气不同时刻pH值的上升与PaCO_(2)降低优于对照组,但差异无统计学意义(P>0.05)。观察组平均潮气量(VT)(520.00±50.00)ml、每分钟静息通气量(VE)(9.77±1.30)L min高于对照组,呼吸频率(RR)(16.00±1.00)次min、平均漏气量(Lleak)(18.00±6.00)L min明显低于对照组,人均呼吸机吸氧时间日(TA)(7.35±2.44)h和人均带机时间(TB)(52.89±9.85)h高于对照组,差异有统计学意义(t=9.979、6.999、11.366、9.347、7.944、11.672,P<0.05)。观察组患者机械通气治疗依从性90.0%高于对照组71.43%,差异有统计学意义(χ^(2)=4.499,P<0.05)。观察组气管插管率7.50%、面部压伤7.50%、胃肠胀气5.00%、吸入性肺炎2.50%和眼结膜炎2.50%均低于对照组,差异有统计学意义(P<0.05)。结论无创机械通气平均容积保证压力支持AVAPS模式减少呼吸肌做功,人机协调性好,较BiPAP显示出一定的优越性。

Objective This study aims to analyze the therapeutic value of non-invasive ventilation with AVAPS mode in COPD patients with typeⅡrespiratory failure.Methods A total of 82 COPD patients with typeⅡrespiratory failure admitted to Liangxiang hospital were included in the study based on inclusion and exclusion criteria.The patients were randomly divided into two groups,the control group(n=42)receiving BiPAP S T mode with internal medical treatment,and the observation group(n=40)receiving AVAPS mode(S T+VT target)with the same internal medical treatment.The changes in arterial blood gas parameters,ventilation effectiveness,and incidence of ventilator-related complications were observed.Results In the control group,5 patients were intolerant to the ventilator,and 8 patients failed treatment and required endotracheal intubation.In the observation group,2 patients were intolerant to the ventilator,and 3 patients required endotracheal intubation.However,after intubation,the 18 patients above were transferred to the RICU and no deaths occurred.Other patients in both groups recovered and were discharged.At 6~8 hours,1 day,3 days,and 7 days of ventilator treatment,the observation group showed a better increase in pH and decrease in PaCO_(2) compared to the control group,but the difference was not statistically significant(P>0.05).After mechanical ventilation,the observation group had higher ventilation parameters VT(520.00±50.00)ml and VE(9.77±1.30)L min compared to the control group,while RR(16.00±1.00)times min and Lleak(18.00±6.00)L min were significantly lower in the observation group than the control group.The differences in TA(7.35±2.44)h and TB(52.89±9.85)h between the two groups were statistically significant(t=9.979,6.999,11.366,9.347,7.944,11.672,P<0.05).The compliance rate of mechanical ventilation in the observation group(90.0%)was higher than in the control group(71.43%)(χ^(2)=4.499,P<0.05).The incidence of endotracheal intubation(7.50%),facial pressure sores(7.50%),and gastrointestinal distension(5.00%)in the observation group were lower than in the control group,and the differences were statistically significant(P<0.05).The occurrence of aspiration pneumonia(2.50%)and conjunctivitis(2.50%)in the observation group was lower than in the control group,with statistically significant differences(P<0.05).Conclusion Non-invasive ventilation with AVAPS mode reduces the work of breathing in COPD patients with typeⅡrespiratory failure,improves patient-ventilator synchrony,and demonstrates certain advantages compared to BiPAP mode.