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目的通过适应性支持通气(ASV)模式与压力控制下的辅助/控制通气(PCMV)模式的对比研究,评价ASV的临床应用价值。方法各种原因导致的急性呼吸衰竭患者12例,所有患者均行气管插管,存在自主呼吸。按PCMV1-ASV-PCMV2顺序行机械通气;前后两次PCMV的设置不变。ASV模式行机械通气时,调整分钟通气量百分比(MV%)和患者理想体重(IBW),使之达到和PCMV机械通气时相同的分钟通气量,并记录各项指标。比较每次机械通气后45min的血气分析、呼吸力学、患者所做的功(WOB)、气道闭合压(P0.1)、吸气时间压力乘积(PTP)以及血流动力学等各项指标。结果前后两次PCMV模式机械通气后各项指标无明显差异(P>0.05)。ASV与第1次的PCMV相比,各项血气分析及呼吸力学指标无显著差异;患者所做的呼吸功(WOB)、气道闭合压(P<0.1)、吸气时间压力乘积(PTP)则明显降低(P<0.05);各项血流动力学指标无显著差异(P>0.05)。结论 ASV能获得与常规通气模式相似的通气目标,在减少患者的做功,降低中枢呼吸驱动方面较PCMV具有优越性。
Objective To evaluate the clinical value of ASV by comparing the mode of ASV with the mode of assisted / controlled ventilation (PCMV) under pressure control. Methods Acute respiratory failure caused by various causes in 12 patients, all patients underwent tracheal intubation, there is spontaneous breathing. According to PCMV1-ASV-PCMV2 sequence of mechanical ventilation; PCMV settings before and after the same. In ASV mode, the percentage of minute ventilation (MV%) and patient’s ideal body weight (IBW) were adjusted to achieve the same minute ventilation as mechanical ventilation of PCMV with mechanical ventilation, and the indicators recorded. Blood gas analysis, respiration mechanics, work done by patients (WOB), airway closure pressure (P0.1), time-pressure product of inspiration (PTP) and hemodynamics were compared at 45min after each mechanical ventilation . Results before and after the two mechanical ventilation after PCMV mode no significant difference (P> 0.05). Compared with the first PCMV, there was no significant difference between the ASV and the first PCMV. The WOB, airway pressure (P <0.1), PTP (P <0.05). There was no significant difference in all hemodynamic parameters (P> 0.05). Conclusions ASV can achieve ventilation goals similar to those of conventional ventilation, and is superior to PCMV in reducing the work of patients and reducing central respiratory drive.