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目的探讨成比例辅助机械通气(PAV)与无创正压通气(NIPPV)模式对慢性阻塞性肺疾病(COPD)患者的临床作用。方法在常规药物治疗的基础上,应用PAV或NIPPV通气模式治疗COPD患者各40例,观察并比较不同通气模式下患者动脉血气分析指标(pH值、PaO2、PaCO2)及呼吸力学变化,包括潮气量(VT)、每分通气量(MV)、气道峰压(PIP)和吸气/呼吸周期时间比(Ti/Ttot),并计算平均吸气流速(VT/Ti)。结果与NIPPV通气相比,PAV通气时COPD患者的PIP、VT和VT/Ti明显降低(P<0.05),MV和Ti/Ttotal明显增加(P<0.05)。PAV组连续3 d夜间通气时间大于3 h者为65%(26/40),而NIPPV组仅为20%(8/40),显示PAV组夜间连续通气时间显著延长(P<0.05)。结论与NIPPV通气模式相比,PAV通气模式能明显改善慢性阻塞性肺疾病患者气道峰压,吸气/呼吸周期时间比明显增加,通气依存性好。
Objective To investigate the clinical effect of proportional assisted ventilation (PAV) and noninvasive positive pressure ventilation (NIPPV) on patients with chronic obstructive pulmonary disease (COPD). Methods 40 patients with COPD were treated with PAV or NIPPV ventilation on the basis of routine drug therapy. The arterial blood gas analysis indexes (pH value, PaO2, PaCO2) and respiratory mechanics were observed and compared under different ventilation modes, including tidal volume (VT), MV, PIP, and Ti / Ttot were calculated and mean inspiratory flow rate (VT / Ti) was calculated. Results Compared with NIPPV ventilation, PIP, VT and VT / Ti in COPD patients were significantly decreased (P <0.05) and MV and Ti / Ttotal significantly increased (P <0.05). The PAV group had 65% (26/40) of patients who had nocturnal ventilation for more than 3 hours for 3 days, while only 20% (8/40) for NIPPV patients. The duration of nocturnal continuous ventilation in patients with PAV was significantly longer (P <0.05). Conclusions Compared with NIPPV ventilation model, PAV ventilation can significantly improve the peak airway pressure in patients with chronic obstructive pulmonary disease (COPD), with significantly increased inspiratory / respiratory cycle time and good ventilatory dependence.