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目的 观察比例辅助通气 (PAV)不同辅助比例对慢性阻塞性肺疾病 (COPD)合并呼吸衰竭患者呼吸力学的影响。方法 15例COPD合并呼吸衰竭的患者 ,予以常规药物治疗同时进行经面罩双水平气道正压通气(BiPAP)与PAV辅助通气 ,并按不同辅助比例 80 %、6 0 %、4 0 %和 2 0 %分别通气 30min后采集数据。监测患者在不同通气模式时气道峰压 (PIP)、呼吸频率 (RR)、潮气量 (VT)、每分钟通气量 (MV)和吸气 /呼吸周期时间比 (Ti/Ttotal)的变化 ,并计算平均吸气流速 (VT/Ti)。结果 在EPAP/CPAP相同情况下 ,PAV通气时的PIP和VT/Ti与BiPAP(S)相比有显著降低 (P <0 0 5 ) ,Ti/Ttotal与BiPAP(S)相比显著升高 (P <0 0 5 ) ,而MV无明显变化 (P >0 0 5 )。PAV辅助比例为 2 0 %时的VT明显低于BiPAP(S)时的VT(P <0 0 5 ) ,同时低于辅助比例为 4 0 %时的VT(P <0 0 5 )。当PAV辅助比例≥ 4 0 %时 ,所有患者的VT在不同辅助比例时均无明显变化 ,且与BiPAP(S)时VT相比差异也无显著性 ( P >0 0 5 ) ;同样在辅助比例≥ 4 0 %时 ,所有患者的RR、MV、Ti/Ttotal和VT/Ti变化差异也无显著性 (P >0 0 5 )。结论 PAV不同辅助比例与BiPAP(S)相比 ,PIP显著降低。PAV适宜的辅助比例在 4 0 %～80 %。
Objective To investigate the effects of different auxiliary proportions of proportion assisted ventilation (PAV) on respiratory mechanics in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods Fifteen patients with COPD and respiratory failure were treated with conventional medical therapy and double-mask positive airway pressure (BiPAP) and PAV-assisted ventilation. The patients were divided into two groups according to different auxiliary ratios of 80%, 60%, 40% and 2 0% were ventilated 30min after collecting data. The change of peak pressure (PIP), respiratory rate (RR), tidal volume (VT), ventilation rate per minute (MV) and inspiratory / respiratory cycle time ratio (Ti / Ttotal) were monitored in different ventilation modes. And calculate the average inspiratory flow rate (VT / Ti). Results Compared with BiPAP (S), PIP and VT / Ti significantly decreased (P <0 05) and Ti / Ttotal significantly increased compared with BiPAP (S) at the same time of EPAP / CPAP P <0 05), while there was no significant change in MV (P> 0.05). The VT at 20% PAV was significantly lower than that at BiPAP (S) (P <0 05) and lower than at VT 40% (P 0 05). When the PAV auxiliary ratio ≥ 40%, all patients had no significant change in the different auxiliary ratio of VT, and compared with BiPAP (S) VT was no significant difference (P> 0.05); the same in the auxiliary There was no significant difference in RR, MV, Ti / Ttotal and VT / Ti in all patients when the proportion ≥ 40% (P> 0.05). Conclusions Compared with BiPAP (S), the PIP of different auxiliary ratios of PAV is significantly lower. PAV suitable auxiliary ratio of 40% to 80%.