几种不同通气模式对急性呼吸衰竭患者通气、血流动力学影响的比较

摘要

目的　观察比例辅助通气（PAV）在临床初步应用疗效及其对急性呼吸衰竭患者呼吸、循环功能影响，并与间歇正压通气（IPPV）、压力支持通气（PSV）进行比较，为PAV临床广泛应用奠定基础。rn方法　对10例急性呼衰患者先用IPPV模式通气，同时计算弹性阻力(Ers)和粘性阻力(Rrs)，然后将模式改为PSV，根据IPPV时数据设置支持压力，使得V T与IPPV时大致相同。再将模式改为PAV，根据PSV时的数据设置辅助百分比，使得潮气量（V T）和峰压（Ppeak）分别与PAV时大致相同。观察通气期间呼吸力学、血气和血流动力学的变化。rn结果　PAV和PSV、IPPV相比，在V T相似的情况下，其Ppeak显著低，其患者呼吸功（WOBp）、呼吸机呼吸功（WOBv）均较PSV、IPPV低；PAV与PSV相比，各血流动力学参数间无显著差异，PAV与IPPV相比，其CVP和PCWP较IPPV显著低。PAV与PSV相比，在Ppeak相似的情况下，PAV时V T、平均动脉压（mBP）、心输出量（CO）较PSV高，其平均肺动脉压（mPAP）、WOBp较PSV低，其中WOBp显著低。rn结论　在临床急性呼衰患者中，PAV与PSV、IPPV相比，其气道压力低，呼吸功减少，对血流动力学影响较小。%Objective To compare the influence of cardiac-pulmonary function on clinical acute respir atory failure patients using Proportional assist ventilation (PAV), Pressure sup port ventilation (PSV) and intermittent positive pressure ventilation (IPPV). H ere, we also describe some our experience with the clinical use of PAV. rnMethods Using the IPPV mode in ten acute respiratory failure patients, calculate Elastan ce (Ers) and Resistance (Rrs), then change to PSV, set inspiratory positive airw ay pressure (IPAP) according to IPPV, so that tidal volume (VT) is the same as that of IPPV. We then changed the mode into PAV and set the assist ratio accor ding to PSV, so that VT and Ppeak were the same as that of PSV. Then we obser ved the changes of respiratory mechanics, blood gas levels and hemodynamics duri ng ventilation. rnResults Compared with PSV and IPPV, peak pressure (Ppeak) of PAV was markedly lower whil e VT was similar; work of breathing of patient (WOBp), and work of breathing o f ventilation (WOBv) were also lower; center vein pressure (CVP) and pulmonary c apillary wedge pressure (PCWP) of PAV were markedly lower than that of IPPV whil e VT were similar. Compared with PSV, VT, mean blood pressure (mBP) and car diac output (CO) of PAV were higher. Mean pulmonary artery pressure (mPAP) and WOBp of PAV were lower while Ppeak was similar; the differences in WOBp were not able. rnConclusions For clinical acute respiratory failure patients, compared with PSV and IPPV, PAV has lower airway pressure、less WOBp and less influence on hemodynamics.