CAJ | 학술논문

目的：通过比较适应性支持通气与自主呼吸试验方法对准备撤机患者呼吸力学参数的影响，指导临床撤机。方法入选32例机械通气的患者，在治疗过程中均达到撤机标准。所有患者先后采用3种方法的呼吸试验即ASV（适应性支持通气）、低水平PSV （7 cm H2 O）和T管试验，每次呼吸试验持续20 min，每种呼吸试验结束时，以下通气参数被记录：潮气量（ VT）、呼吸频率（ RR）、血氧饱和度（ SaO2）、气道闭合压（ P0.1）、最大吸气压（ Pimax）和呼吸浅快指数（ RSBI），比较在采用3种不同方法时各呼吸力学参数的差异。结果30例患者成功完成了3种呼吸试验，在应用ASV、低水平PSV时，患者的P0.1、Pimax、RSBI和RR与T管比较均明显降低，而VT和SaO2均增加，ASV组、低水平PSV组各参数与T管组比较差异均有统计学意义（ P＜0.05），低水平PSV组P0.1、VT与ASV组比较是下降的，而RR是增高的，差异有统计学意义（ P＜0.05）。结论应用ASV组、低水平PSV进行自主呼吸试验优于T管试验，ASV组更有优势，对临床进行撤机具有一定指导意义。
목적：통과비교괄응성지지통기여자주호흡시험방법대준비철궤환자호흡역학삼수적영향，지도림상철궤。방법입선32례궤계통기적환자，재치료과정중균체도철궤표준。소유환자선후채용3충방법적호흡시험즉ASV（괄응성지지통기）、저수평PSV （7 cm H2 O）화T관시험，매차호흡시험지속20 min，매충호흡시험결속시，이하통기삼수피기록：조기량（ VT）、호흡빈솔（ RR）、혈양포화도（ SaO2）、기도폐합압（ P0.1）、최대흡기압（ Pimax）화호흡천쾌지수（ RSBI），비교재채용3충불동방법시각호흡역학삼수적차이。결과30례환자성공완성료3충호흡시험，재응용ASV、저수평PSV시，환자적P0.1、Pimax、RSBI화RR여T관비교균명현강저，이VT화SaO2균증가，ASV조、저수평PSV조각삼수여T관조비교차이균유통계학의의（ P＜0.05），저수평PSV조P0.1、VT여ASV조비교시하강적，이RR시증고적，차이유통계학의의（ P＜0.05）。결론응용ASV조、저수평PSV진행자주호흡시험우우T관시험，ASV조경유우세，대림상진행철궤구유일정지도의의。
Objective To investigate the effect of spontaneous breathing trials (SBT) and adaptive support ventilation (ASV) on re-spiratory mechanics parameters to guide to quit the use of mechanics.Methods 32 patients who were ready for weaning were enrolled. All patients underwent three methods:ASV, low level pressure support ventilation ( PSV,7 cm H2 O) and T-piece.Each breathing trials continued for 20min, the respiratory mechanics parameters included: tidal volume(TV), breathing rate(RR),blood oxygen saturation (SaO2),airway occlusion pressure(P0.1), maximal inspiratory mouth pressure(Pimax) and rapid shallow breathing index(RSBI)were measured before each trial.Their differences between spontaneous breathing trials and ASV were compared .Results 30 patients success-fully completed different breathing methods .Compared with the T-piece,P0.1 ,Pimax,RSBI and RR in the patients using low level PSV and ASV were significantly decreased while VT and SaO 2 increased .The difference of each parameter in the low level PSV group and ASV had statistical significance compared with T -piece group ( P<0.05 ) .Compared with the low PSV group , P0.1 , VT in ASV group elevated while RR reduced.The difference between two groups were statistically significant ( P<0.05 ).Conclusion For ventilation patients in weaning process with spontaneous breathing trial ,low levels of PSV and ASV are better than T -piece,and the ASV group has more advanta-ges.It has certain guiding significance for clinic.