经面罩机械通气治疗慢性阻塞性肺病呼吸衰竭患者

比较压力支持通气（ＰＳＶ）和辅助／控制（Ａ／Ｃ）通气的优缺点。（１）２６例慢性阻塞性肺病（慢阻肺）呼吸衰竭患者经面罩压力支持通气，比较ＰＳＶ模式有效与效果不佳者的临床特点及处理方法；（２）８例患者病情相对稳定后进行ＰＳＶ模式与Ａ／Ｃ模式的比较以及呼气末正压（ＰＥＥＰ）通气的疗效测定。结果：用ＰＳＶ模式，所有患者皆完成了从自主呼吸到面罩机械通气的过渡。此后分别有７例和４例患者需改用 Ａ／ Ｃ或加用 ＳＩＭＶ模式。与Ａ／ Ｃ模式比较，用 ＰＳＶ模式通气不仅耐受性好，且可允许较低的气垫内压，并具有漏气量少、动态死腔小、有效通气量高等优点。低水平ＰＥＥＰ可提高氧分压，而对血流动力学及面罩的密闭性能无不良影响。结论：ＰＳＶ模式可作为经面罩机械通气的首选模式，Ａ／ Ｃ模式则为必要补充，ＰＥＥＰ有一定的应用价值。

MECHANICAL VENTILATION VIA FACE MASK IN COPD PATIENTS WITH RESPIRATORY FAILURE (THE COMPARISON OF VENTILATING MODES)

PURPOSE Comparing the effect of various ventilating modes in the treatmemt of chronic obstructive pulmonary disease (COPD) patients with respiratory failure via face mask mechanical ventilation METHODS 26 COPD patients with respiratory failure received pressure surpport ventilation (PSV) via face mask. Assit/ control (A/ C) mode or synchronized intermittent madatory ventilation (SIMV) mode was given when PSV was poor triggering. PSV and A/ C mode was compared in 8 patients who was in " constant state". RESULTS The peak pressure reached l-2.5kPa, and Spontaneous breathing of all patients was successfully substituted by mechanical ventilation as PSV. Thereafter, in 7 patients with obvious respiratory muscle fatigue and 2 patients with sleep-apnea syndrome, A/ Cor SIMV mode was given because of poor triggering. In other 2 patients, SIMV mode was used on the second day as arterial blood gases were not improved. PSV mode was not only better tolerated, but also had lower mask pressure on face, less gas leak, smaller dead space, and higher ventilating efficacy than A/ C mode. The lower positive end-expiratory pressure (PEEP) could improve Pao2, but did not worsen blood dynamics. CONCLUSIONS PSV may be used firstly in the mechanical ventiating treatmemt of respiratory failure via face mask. The rational selection of A/ C or SIMV mode can raise effective rate. PEEP has some value in improving gas exchange.