中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
16期
16-18
,共3页
王金生%杨轶敏%唐容辉%周永江%唐倩仪
王金生%楊軼敏%唐容輝%週永江%唐倩儀
왕금생%양질민%당용휘%주영강%당천의
哮喘%肺通气
哮喘%肺通氣
효천%폐통기
Asthma%Pulmonary ventilation
目的 探讨适应性支持通气(ASV)治疗危重哮喘的效果.方法 将49例危重哮喘患者按随机数字表法分为ASV组(25例)和对照组(传统机械通气,24例).比较两组患者机械通气前后的动脉血气分析、呼吸力学、机械通气时间、住院时间及胸部气压伤发生情况.结果 两组机械通气后动脉血气分析和呼吸力学指标均较机械通气前明显改善,差异有统计学意义(P＜ 0.05或＜0.01),但ASV组机械通气后2、12、24h气道峰压、肺动态顺应性、平台压均较同期对照组明显改善[机械通气后2 h:(33±12) cm H2O(1 cm H2O =0.098 kPa)比(37±11) cm H2O、(16±9)ml/ cm H2O 比(17±10) ml/cm H2O、(27±6)cm H2O比(30±12) cm H2O;机械通气后12 h:(23±12) cmH2O比(25±11) cmH2O、(28±6)ml/cm H2O比(23±10) ml/cm H2O、(20±6)cm H2O比(25±4)cm H2O;机械通气后24 h:(18±12) cm H2O比(20±11)cm H2O、(32±9)ml/cm H2O比(28±10) ml/cm H2O、(12±7)cm H2O比(16±7)cm H2O],差异有统计学意义(P＜ 0.05或＜0.01).ASV组机械通气时间、住院时间明显短于对照组[(46±8)h比(56±6)h、(7±2)d比(10±3)d],差异有统计学意义(P＜0.01).ASV组无胸部气压伤发生,对照组发生3例皮下气肿、2例气胸.结论 ASV在治疗危重哮喘患者时,能够保持较低的气道峰压和平台压,改善动脉血气分析和肺动态顺应性,缩短机械通气时间以及住院时间,是一种安全而有效的机械通气模式.
目的 探討適應性支持通氣(ASV)治療危重哮喘的效果.方法 將49例危重哮喘患者按隨機數字錶法分為ASV組(25例)和對照組(傳統機械通氣,24例).比較兩組患者機械通氣前後的動脈血氣分析、呼吸力學、機械通氣時間、住院時間及胸部氣壓傷髮生情況.結果 兩組機械通氣後動脈血氣分析和呼吸力學指標均較機械通氣前明顯改善,差異有統計學意義(P＜ 0.05或＜0.01),但ASV組機械通氣後2、12、24h氣道峰壓、肺動態順應性、平檯壓均較同期對照組明顯改善[機械通氣後2 h:(33±12) cm H2O(1 cm H2O =0.098 kPa)比(37±11) cm H2O、(16±9)ml/ cm H2O 比(17±10) ml/cm H2O、(27±6)cm H2O比(30±12) cm H2O;機械通氣後12 h:(23±12) cmH2O比(25±11) cmH2O、(28±6)ml/cm H2O比(23±10) ml/cm H2O、(20±6)cm H2O比(25±4)cm H2O;機械通氣後24 h:(18±12) cm H2O比(20±11)cm H2O、(32±9)ml/cm H2O比(28±10) ml/cm H2O、(12±7)cm H2O比(16±7)cm H2O],差異有統計學意義(P＜ 0.05或＜0.01).ASV組機械通氣時間、住院時間明顯短于對照組[(46±8)h比(56±6)h、(7±2)d比(10±3)d],差異有統計學意義(P＜0.01).ASV組無胸部氣壓傷髮生,對照組髮生3例皮下氣腫、2例氣胸.結論 ASV在治療危重哮喘患者時,能夠保持較低的氣道峰壓和平檯壓,改善動脈血氣分析和肺動態順應性,縮短機械通氣時間以及住院時間,是一種安全而有效的機械通氣模式.
목적 탐토괄응성지지통기(ASV)치료위중효천적효과.방법 장49례위중효천환자안수궤수자표법분위ASV조(25례)화대조조(전통궤계통기,24례).비교량조환자궤계통기전후적동맥혈기분석、호흡역학、궤계통기시간、주원시간급흉부기압상발생정황.결과 량조궤계통기후동맥혈기분석화호흡역학지표균교궤계통기전명현개선,차이유통계학의의(P＜ 0.05혹＜0.01),단ASV조궤계통기후2、12、24h기도봉압、폐동태순응성、평태압균교동기대조조명현개선[궤계통기후2 h:(33±12) cm H2O(1 cm H2O =0.098 kPa)비(37±11) cm H2O、(16±9)ml/ cm H2O 비(17±10) ml/cm H2O、(27±6)cm H2O비(30±12) cm H2O;궤계통기후12 h:(23±12) cmH2O비(25±11) cmH2O、(28±6)ml/cm H2O비(23±10) ml/cm H2O、(20±6)cm H2O비(25±4)cm H2O;궤계통기후24 h:(18±12) cm H2O비(20±11)cm H2O、(32±9)ml/cm H2O비(28±10) ml/cm H2O、(12±7)cm H2O비(16±7)cm H2O],차이유통계학의의(P＜ 0.05혹＜0.01).ASV조궤계통기시간、주원시간명현단우대조조[(46±8)h비(56±6)h、(7±2)d비(10±3)d],차이유통계학의의(P＜0.01).ASV조무흉부기압상발생,대조조발생3례피하기종、2례기흉.결론 ASV재치료위중효천환자시,능구보지교저적기도봉압화평태압,개선동맥혈기분석화폐동태순응성,축단궤계통기시간이급주원시간,시일충안전이유효적궤계통기모식.
Objective To study the effect of adaptive support ventilation (ASV) in treatment of severe asthma.Methods Forty-nine cases of severe asthma were divided into ASV group (25 cases) and control group (24 cases,tradition mechanical ventilation).The arterial blood gas,respiratory dynamics,mechanical ventilation time,hospital stay and thorax barotrauma was compared between two groups.Results The arterial blood gas and respiratory dynamics was improved after mechanical ventilation compared with that before mechanical ventilation in two groups,and there was significant difference (P ＜ 0.05 or ＜ 0.01).The airway peak voltage,lung dynamic compliance and platform pressure after mechanical ventilation of 2,12 and 24 h in ASV group was better than that in control group[2 h:(33 ± 12) cm H2O(1 cm H2O =0.098kPa) vs.(37 ± 11) cm H2O,(16 ± 9) ml/cm H2O vs.(17 ± 10) ml/cm H2O,(27 ± 6) cm H2O vs.(30 ±12) cm H2O; 12 h:(23 ± 12) cm H2O vs.(25 ± 11) cm H2O,(28 ± 6) ml/cm H2O vs.(23 ± 10) ml/cm H2O,(20 ±6) cm H2O vs.(25 ±4) cm H2O; 24 h:(18 ± 12) cm H2O vs.(20 ± 11) cm H2O,(32 ±9)ml/cm H2O vs.(28 ± 10) ml/cm H2O,(12 ±7) cm H2O vs.(16 ±7) cm H2O],and there was significant difference(P＜ 0.05 or ＜ 0.01).The mechanical ventilation time and hospital stay in ASV group was shorter than that in control group [(46 ± 8) h vs.(56 ± 6) h,(7 ± 2) d vs.(10 ± 3) d],and there was significant difference (P＜ 0.01).The thorax barotrauma was not observed in ASV group; 3 cases showed subcutaneous emphysema and 2 cases showed pneumothorax in control group.Conclusions ASV mode could decrease airway peak voltage and platform pressure,improve arterial blood gas and lung dynamic compliance,shorten mechanical ventilation time and hospital stay.It is safe and effective for patients with severe asthma.
