不同通气模式下慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者机体的炎症反应

目的探讨不同通气模式对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的影响以及机体的炎症反应。方法选择厦门大学附属中山医院2007年1月至2012年6月收治的COPD合并Ⅱ型呼吸衰竭患者102例,根据不同的机械通气模式分为两组,一组给予适应性支持通气(ASV)模式,另一组给予同步间歇指令通气+压力支持通气(SIMV+PSV)模式,每组51例。观察患者的呼吸形式、呼吸力学、血流动力学指标以及血清炎症因子水平。结果 ASV组的潮气量(VT)明显高于SIMV+PSV模式,指令呼吸频率、通气总时间均明显低于SIMV+PSV模式(P<0.05);ASV组的气道峰压(Ppeak)、平均气道压(Pmean)、气道平台压(Pplat)均明显低于SIMV+PSV组;ASV组的C反应蛋白(CRP)、降钙素原(PCT)、α1酸性糖蛋白(AAG)水平均明显低于SIMV+PSV组。结论 ASV通气模式有利于降低COPD合并Ⅱ型呼吸衰竭患者的机体炎症反应,更快地恢复自主呼吸能力,减少通气时间。

Influence of Different Mechanical Ventilation Modes on Inflammatory Reaction among COPD Patients with Severe Respiratory Failure

Objective To investigate the influence of different mechanical ventilation modes on inflammatory reaction among COPD patients with severe respiratory failure. Methods A total of 102 COPD patients with severe respiratory failure, admitted in Zhongshan Hospital between January 20007 and June 2012 ,were enrolled in this study. The subjects were divided into an ASV group receiving adaptive support ventilation, and a SIMV ＋ PSV group received synchronized intermittent mandatory ventilation and pressure support ventilation, with 51 cases in each group. Breathing pattern, respiratory mechanics, hemodynamic parameters and serum inflammatory factors were examined among all patients. Results Tidal volume （ ~T ） was significantly higher, and the control respiratory rate and ventilation time were significantly lower in the ASV group than those in the SIMV ＋ PSV group （ P 〈 0. 05 ）. Comparing with the SIMV ＋ PSV group, obviously lower peak airway pressure （Ppeak）, mean airway pressure （Pmean） and airway plateau pressure （Pplat） were observed in the ASV group （ P 〈 0.05 ）. The patients in the ASV group had obviously lower levels of C-reactive protein,procalcitonin and αl acid glycoprotein. Conclusion ASV ventilation mode may reduce the inflammatory reaction, facilitate spontaneously breathing and decrease mechanical ventilation time.