适应性支持通气在急性呼吸窘迫综合征中实施肺保护性通气策略的应用研究

目的研究适应性支持通气(ASV)在急性呼吸窘迫综合征(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机械通气患者随机分为ASV组和PSIMV组,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。结果通气24小时后,ASV组较PSIMV组气道峰压(PIP)、平台压(Pplat)显著降低(P<0.05);两组间的血液动力学指标无显著差异(P>0.05);两组治疗24小时后Pa02、氧合指数、静态肺顺应性较治疗前均明显改善(P<0.05)。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,ASV模式更有效减低PIP、Pplat。适应性支持通气在急性呼吸窘迫综合征中实施肺保护性通气策略具备一定优越性。

Studying the Effect of Adaptive Support Ventilation implementing Lung Protection Strategies on patients with Acute Respiratory Distress Syndrome

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 superiorty. Methods 60 ARDS patients with ventilation were randomly divided into ASV group and pressure support synchronized intermittent mandatory ventilation （PSIMV） group,all implementing lung protective ventilation strategies, then compared the variation in respiratory mechanics,blood gas,hemodynamics. Results After 24 hours＂ ventilation,the peak inspiratory pressure （PIP） and the plat pressure（Pplat） of ASV group were lower than those of the PSIMV group（P〈0.05） ;the the variation in hemodynamics showed no significant difference（P〉0. 05）;Pa02 ,Pa02/Fi02 and the Static compliance （Cstat） of two groups were dramatically improve than those before treatment（P〈0.05）. Conclusion When ARDS pa- tients implementing LPS, ASV and PSIMV ventilation modes all can improve patients＂ oxygenation. ASV mode can con- trol PIP and Plate more efficient. Consequently, ASV implementing LPS on patients with ARDS has certain superiorty.