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目的建立比例辅助通气（PAV）临床应用的方法，评价其治疗慢性阻塞性肺疾病（COPD）急性发作期患者的疗效，并与压力辅助通气（PSV）比较。方法选取10例COPD插管机械通气患者，分别采用吸气阻断法和脱逸法设定参数。每例随机先后采用PAV或PSV，PAV辅助比例分别设为80％、60％和40％。同时监测主观感受、血流动力学、氧动力学和呼吸力学指标。结果吸气阻断法与脱逸法设定的参数有很好的相关性r＝0．928（P＜0．01）。PAV不同的辅助比例只影响吸气峰压、呼吸机及患者做功，对通气指标无显著影响（P＞0．05）。对循环功能稳定者，PAV组与PSV组的血流动力学指标差异无显著性（P＞0．05），氧合均保持在满意水平。PAV组比PSV组潮气量有减小趋势（P＞0．05），动脉血二氧化碳分压（PaCO2）显著增高（P＜0．05），吸气峰压显著减低（P＜0．05）。结论采用脱逸法设定参数简单可靠。PAV是安全有效的通气模式，人机协调性好。在做功相同时，PAV比PSV吸气峰压降低，并根据患者的需要保持相应的通气量。
Objective To establish a method for the clinical application of proportional Assisted Ventilation (PAV) and evaluate its efficacy in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and compare with those of pressure assisted ventilation (PSV). Methods Ten patients with COPD intubated mechanical ventilation were selected, inhalation block method and escape method parameters were set. In each case, PAV or PSV was used randomly. The PAV auxiliary ratio was 80%, 60% and 40% respectively. Subjective feelings, hemodynamics, oxygen dynamics, and respiratory mechanics were also monitored. Results There was a good correlation between inhalation blockade and parameters set by the escape method (r = 0.928, P <0.01). PAV different auxiliary ratio only affect the inspiratory peak pressure, ventilator and patient work, no significant impact on ventilation parameters (P> 0.05). There was no significant difference in the hemodynamic parameters between PAV group and PSV group (P> 0.05). The oxygenation was maintained at a satisfactory level. The tidal volume of PAV group was lower than that of PSV group (P> 0.05), the PaCO2 of arterial blood group was significantly increased (P <0.05), the inspiratory peak pressure was significantly lower (P <0.05) . Conclusion The desorption method is simple and reliable. PAV is a safe and effective ventilation mode, good man-machine coordination. At the same time as the work is done, the PAV has a lower peak inspiratory pressure than the PSV and maintains the appropriate ventilation for the patient’s needs.