摘要
目的探讨适应性支持通气（adaptive support ventilation，ASV）模式在慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）机械通气稳定期患者中的应用及护理。方法2004年1月至2005年3月，选择我院老年病房长期住院COPD患者11例，先后应用容量-辅助控制（control mechanical ventilation，CMV）通气模式（潮气量7-9ml·kg^-1·min^-1。呼吸频率16—18次／min）和ASV通气模式进行自身前后对照。应用每种呼吸模式时，待患者呼吸、心率平稳30min后，记录患者的呼吸力学指标，同时测心率、麻压，并抽取动脉血进行血气分析。应用ASV模式前做好心理护理，通气中保持气道通畅，重点加强人工气道固定、湿化及吸痰等护理。结果与CMV模式相比，应用ASV模式的患者潮气量和呼吸频率增加，同时，吸气流速、呼气时间和吸气时间均增高（P＜0．05）；呼气流速下降（P＜0．05）；气道峰压、平均气道压、吸气阻力和呼气阻力无变化（P〉0．05），患者舒适度好。结论稳定期COPD患者应用ASV模式，人机协调性好，安全性高，可减少患者的呼吸用力。
Objective To study the clinical application of adaptive support ventilation （ASV） in stable chronic obstructive pulmonary disease （COPD） patients on long term ventilation and nursing strategy. Methods Eleven elderly patients with stable COPD （on long term ventilation） were selected for this study from Jan 2004 to Mar 2005. Control mechanical ventilation （ CMV, tidal volume being 7 - 9 ml · kg^-1 ·min^-1, respiratory rate being 16 - 18/min） and ASV were used for the patients separately. The variables of respiratory mechanics were recorded 30 min after the respiration and heart rate became stable. Meanwhile, the variables of hemodynamics （heart rate and blood pressure） and arterial blood analysis were measured after 2 modes of ventilation. The patients received good psychological nursing before they were put on ASV. During the ASV, the airways of patients were kept open; the artificial airways were well fixed, humidified; and the sputum was aspirated. Results Compared with CMV, ASV had an increased tidal volume and decreased respiratory rate; meanwhile, inspiratory flow, inspiratory time constants, and expiratory time constants were also higher after receiving ASV （ P 〈 0.05 ） ; the expiratory flow was lower after receiving ASV（ P 〈0.05） ; the airway peak pressure, mean airway pressure, inspiratory resistance, and expiratory resistance had no change（ P 〉 0.05）. Patients felt more comfortable after they received ASV. Conclusion ASV can be safely applied in patients with stable COPD, with less respiratory effort and better good tolerance.
出处
《解放军护理杂志》
2007年第1期14-16,共3页
Nursing Journal of Chinese People's Liberation Army
关键词
适应性支持通气
慢性阻塞性肺疾病
人工气道
护理
adaptive support ventilation
chronic obstructive pulmonary disease
artificial airway
nursing
