适应性支持通气对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者呼吸力学的影响

目的 探讨适应性支持通气(adaptive support ventilation,ASV)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并Ⅱ型呼吸衰竭患者呼吸力学的影响.方法 采用自身对照,对26例COPD合并Ⅱ型呼吸衰竭患者,序贯应用压力控制同步间歇指令压力支持通气模式和ASV模式进行机械通气,记录两种模式下的各项呼吸力学参数.结果 总呼吸频率降低及潮气量升高(P＜0.05);平台压、平均气道压、顺应性、0.1秒的口腔闭合压,生命体征、血气分析和血流动力学的相关指标均无明显变化(P＞0.05).结论 ASV对COPD合并Ⅱ型呼吸衰竭患者,可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量、降低呼吸频率,而对血流动力学和生命体征无明显影响.

Efficacy of adaptive support ventilation on respiratory mechanics of patients with chronic obstructive pulmonary disease with hypercapnic respiratory failure

Objective To explore the efficacy of adaptive support ventilation on the respiratory mechanics of patients with chronic obstructive pulmonary disease(COPD)with hypercapnic(TypeⅡ) respiratory failure.Methods Twenty-six patients with COPD with TypeⅡrespiratory failure had vetilated by the same ventilator.They were all applied pressure control synchronized intermittent mandatory ventilation plus inspiration pressure support(P-SIMV+PSV)and adaptive support ventilation(ASV)respectively during the stage.The parameters of respiratory mechanics,hemodynamics and blood analysis were compared during P-SIMV+PSV and ASV.Results Total respiratory rates decreased significantly (P<0.05).The tidal volume increased significantly(P<0.05).The plateau pressure and mean airway pressure had no changes.The compliance and P0.1 had no changes.No changes were noted in the parameters of vital signs,blood analysis and hemodynamics(P>0.05).Conclusions In patiens with COPD with Type Ⅱ respiratory failure,ASV may automatically adjust inspiratory pressure,the tidal volume increases and respiratory rate decreases with the respiratory mechanics of each patient,which may not affect hemodynamics and vital signs.