目的 探讨适应性支持通气(ASV)在慢性阻塞性肺疾病急性加重期(acute chronic obstruc-tive pumonary disease,AECOPD)Ⅱ型呼吸衰竭患者中的临床意义.方法 选择AECOPDⅡ型呼吸衰竭机械通气患者58例,将其随机分为两组,观察组(ASV组)29例,对照组同步间竭指令通气+压力支持通气+呼气末正压(SIMV+ PSV+ PEEP组)29例,两组同时进行机械通气治疗直至撤机,比较两种模式下的各项呼吸力学及血流动力学参数、血气分析、舒适程度、通气时间和撤机成功率.结果 全部患者均成功脱机,ASV组呼吸频率明显下降,潮气量(VT)明显升高(P＜0.05),气道峰压(Ppeak)和吸气阻力(R)下降显著(P＜0.05),静态顺应性(Cstat)逐渐增加(P＜0.05),附加附加功(WOBimp)吸气压力时间乘积(PTP)均低于SIMV+ PSV+ PEEP组(P＜0.01).上机时间明显缩短(P＜0.05).结论 ASV可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量,降低呼吸频率,呼吸肌做功减少,改善人机协调性,并能缩短上机时间,明显优于常规通气,而且操作简单,值得推广应用.%Objective To investigate the clinical value of the adaptive support ventilation (ASV) in patients with AECOPD II respiratory failure. Methods 58 cases with AECOPD II respiratory failure needed mechanical ventilation were randomly divided into twogroups, the observation group ( ASV) for 29 cases, 29 cases of the control group between synchronized mandatory ventila-tion exhaust ventilation + pressure support ( SIMV + PSV + PEEP) ,two groups at the same time mechanical ventilation until weaning, compared records of the two modes of respiratory mechanics and hemodynamic parameters, blood gas analysis, comfort, ventilation time and the success rate of weaning. Results All patients were successfully offline, significantly reducedrespiratory frequency, tidal volume ( VT) increased signifi-cantly(P<0. 05) .peak airway pressure( Ppeak) and inspiratory re-sistance (R) decreased significantly (P<0. 05) .intravenous compliance (Cstat) gradually increased (P <0. 05) . WOBimp.PTP I^fRT SIMV + PSV + PEEPgroup(/> <0. 01). ASV machineventilation on patients with significantly shortened ( P < 0. 05). Conclusion ASV under conditions of respiratory mechanics inpatients with auto-adjust at the level of inspiratory pressure support and enhance tidal volume, reducing respiratory rate, and on hemodynamics and do not affect vital signs, and can shorten the time the machine, it is obviously superior to con-ventional ventilation, and easy to operate and is worth to promote the clinical application.
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