适应性支持通气在急性呼吸窘迫综合征中实施保护性通气策略的研究

目的研究适应性支持通气(ASV)在急性呼吸窘迫综合症(ARDS)中实施肺保护通气策略的应用,并探讨其优越性。方法 60例ARDS患者随机分为ASV组和PSIMV组进行机械通气,均实行肺保护通气策略,比较两组患者呼吸力学、血气及血流动力学各指标的变化,以及1 w内镇静剂用量、撤机时间、入住ICU时间、死亡率。结果通气24 h后,ASV组较PSIMV组气道峰压(PIP)、平台压(Pplat)均降低(p<0.05);两组间的血液动力学指标无差异(p>0.05);两组治疗24 h后PaO2、氧合指数、静态肺顺应性均较前改善(p<0.05),ASV组1 w内使用镇静剂用量、撤机时间,住ICU时间均小于PSIMV组(p<0.05),但死亡率无统计学差异。结论对于ARDS患者在实行肺保护通气策略时,ASV和PSIMV通气模式均可改善氧合,死亡率无统计学差异。ASV模式更有效减低PIP、Pplat,能减少镇静剂用量,缩短机械通气时间。适应性支持通气在急性呼吸窘迫综合症中实施肺保护性通气策略具备一定优越性。

STUDY ON THE IMPLEMENTATION OF LUNG PROTECTION STRATEGIES ON PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME BY MEANS OF ADAPTIVE SUPPORT VENTILATION

Objective To study the effect of Adaptive Support Ventilation(ASV) implementing Lung Protection Strategies(LPS) on patients with Acute Respiratory Distress Syndrome(ARDS),and discuss its superiority.Methods 60 ARDS patients were randomly divided into ASV group and pressure support synchronized intermittent mandatory ventilation(PSIMV) group and treated with mechanical ventilation,all implementing lung protective ventilation strategies,compared the variation in respiratory mechanics,blood gas,hemodynamics,the dosage of sedative drugs within a week,the duration of mechanical ventilation,the days in ICU and mortality.Results After 24 hours′ ventilation,the peak inspiratory pressure(PIP) and the plat pressure(Pplat) of ASV group were decreased than those of PSIMV group(p<0.05);the variation in hemodynamics had no statistics difference(p>0.05);PaO2,PaO2/FiO2and the Static compliance(Cstat) of two groups were improve than those before treatment(p<0.05);the dosage of sedative drugs within a week,the duration of mechanical ventilation and the days in ICU in ASV group were decreased than those in PSIMV group(p<0.05),the mortality has not statistics difference between tow groups.Conclusion When ARDS patients implementing LPS,ASV and PSIMV ventilation modes all can improve patients′ oxygenation.ASV mode can control PIP and Pplate more efficiently,also can reduce the use of sedative drugs and shorten the duration of mechanical ventilation effectively,Consequently,ASV implementing LPS on patients with ARDS has certain superiorty.