摘要
目的探索适应性支持通气模式(ASV)和同步间歇指令通气联合压力支持通气(SIMV+PSV)模式下行机械通气治疗对COPD合并Ⅱ型呼吸衰竭患者呼吸、血气指标及炎症反应的影响。方法选取2015年1月~2017年1月于本院就诊的COPD合并Ⅱ型呼吸衰竭患者105例,根据随机数字法分为研究组52例和对照组53例,观察组采取ASV模式,对照组采取SIMV+PSV模式,治疗2周,记录治疗期间所有患者每天10:00和16:00呼吸机的使用情况,记录呼吸频率(RR)、气道峰压、平均气道压、气道阻力(RAW)、潮气量(Vt)、通气总时间(MV)、呼吸指令频率通气(MRV)等;抽取动脉血行血气分析,检测pH值、动脉氧分压、动脉二氧化碳分压、血氧饱和度、动脉肺泡氧分压差等;并在机械通气治疗结束后抽取静脉血,检测血清C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)、血清基质金属蛋白酶-9(MMP-9)/基质金属蛋白酶组织抑制剂-1(TIMP-1)系统水平。结果观察组RR与对照组差异无统计学意义;观察组的、、RAW、MV、MRV显著低于对照组(P<0.05);观察组的Vt显著高于对照组(P<0.05);两组患者pH值、PaO_2、、SpO_2、差异均无统计学意义;观察组CRP、PCT、IL-6、TNF-α、MMP-9/TIMP-1水平显著低于对照组(P<0.05)。结论 ASV模式用于COPD合并Ⅱ型呼吸衰竭患者,可以改善通气状态,缩短通气时间,减轻机体炎症反应,促进自主呼吸能力恢复。
Objective Exploration of adaptive support ventilation(ASV)and synchronized intermittent mandatory ventilation and pressure support ventilation(SIMV+PSV)mode under mechanical ventilation in the treatment of respiratory patients with type II respiratory failure of COPD blood gas index and inflammatory reaction.Methods From January 2015 to January 2017 COPD with type II respiratory failure patients in our hospital in 200 cases,according to randomly divided into study group and control group with 100 cases in each group,the observation group adopted ASV model,while the control group adopted SIMV+PSV mode,2 weeks of treatment,the use of records of all the patients during the treatment of 10:00 and 16:00 every day ventilator,recording of respiratory frequency(RR),peak airway pressure(Ppeak),mean airway pressure(Pmean),airway resistance(RAW),tidal volume(Vt),ventilation time(MV),respiratory frequency(MRV)instruction ventilation data extraction of arterial blood for blood gas analysis and detection of pH value arterial oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygen saturation(SpO2),Alveolar arterial oxygen difference(PA-aO2);and selected at the end of mechanical ventilation before and after intravenous treatment of mechanical ventilation Serum levels of C reactive protein(CRP),procalcitonin(PCT),IL-6 and TNF-αwere detected.Results The observation group RR had no significant difference with control group,the observation group Ppeak,Pmean,RAW,MV and MRV were significantly lower than the control group(P<0.05);the Vt of the observation group was significantly higher than the control group(P<0.05);two patients with pH,PaO2,PaCO2,SpO2 and PA-aO2 had no significant difference,the levels of CRP,PCT,IL-6,TNF-αin observation group was significantly lower than the control group(P<0.05).Conclusion ASV can be used in patients with COPD complicated with type II respiratory failure,which can improve the state of ventilation,shorten the time of ventilation,reduce the inflammatory response,and p
作者
刘远洪
钟斌
Liu Yuanhong;Zhong Bin(Respiratory Medicine of the People's Hospital of Xunwu County,Ganzhou,Jiangxi,342200,China)
出处
《当代医学》
2018年第12期41-45,共5页
Contemporary Medicine
关键词
适应性支持通气
机械通气
COPD
Ⅱ型呼吸衰竭
炎症反应
Adaptive support ventilation
Mechanical ventilation
COPD
Type II respiratory failure
Inflammatory response
