变异性压力支持通气在AECOPD合并呼吸衰竭患者中的应用研究

发布时间：2018-04-11 07:55

本文选题：变异性压力支持通气 + 慢性阻塞性肺疾病急性加重　；参考：《天津医科大学》2017年硕士论文

【摘要】：慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)是最为常见的呼吸系统疾病之一,它的发病率及病死率均较高,稳定期患者可以通过部分药物维持治疗使病情得以控制,而对于慢性阻塞性肺疾病急性加重(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭的患者除了药物治疗外,有创机械通气治疗也起到了重要作用。有创机械通气使疾病得以控制后,患者恢复自主呼吸,从而可以顺利脱离呼吸机,而这一过程通常较为困难,治疗中患者人机协调性差,从而会导致脱机困难,延长治疗时间,一定程度上给患者加大了经济负担。具研究表明,人体在健康平静状态下自主呼吸的呼吸频率、潮气量、以及吸气时间不是固定不变的,是存在变异的。目前,呼吸机的一种新型模式——变异性压力支持通气(Noisy pressure support ventilation,Noisy PSV)出现了,这种新型模式在慢性阻塞性肺疾病急性加重患者的应用情况,尚需进一步研究。研究目的:探讨变异性压力支持通气模式在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者中应用的安全性及可行性,并与传统PSV模式进行对比。研究方法:收集因AECOPD呼吸衰竭入住RICU,行有创机械通气的患者共30例,记录患者的临床资料,在患者由控制通气过渡到自主呼吸后,依据随机顺序各给予PSV及Noisy PSV模式通气治疗2小时,分别记录基线水平及应用两种模式后的生命体征、气体交换、血流动力学及呼吸力学等相关指标,对数据进行统计学分析。研究结果:研究数据显示,在应用传统PSV及Noisy PSV两种模式下,所有患者均可耐受,没有表现出明显的不良反应及不适。将两种模式下患者的心率、平均动脉压、呼吸频率、血气分析PH值、二氧化碳分压、氧分压、氧合指数、血乳酸等指标进行比较,差异没有统计学意义(P0.05)。相对于传统PSV模式,Noisy PSV模式下潮气量的变异系数(CVVT)明显升高(PSV 12.1±8.2%vs.Noisy PSV 23.5±7.3%,P0.05)。在Noisy PSV模式下,潮气量的最高值明显高于传统PSV模式(PSV 12.0±4.1 mL/kg vs.Noisy PSV 14.4±2.9 m L/kg,P0.05),潮气量最低值明显低于传统PSV模式(PSV 5.5±1.6 mL/kg vs.Noisy PSV 3.2±0.9 mL/kg,P0.05),差异具有统计学意义。同时,在应用两种不同模式通气过程中,分别观察1小时人机不同步事件发生数量并记录,可见应用Noisy PSV模式时的人机不同步事件的发生低于应用PSV模式(Noisy PSV 5(4,6)次/h vs.PSV 12(10,13)次/h,P0.05)。研究结论:Noisy PSV模式在AECOPD呼吸衰竭患者中的短期应用安全可行。与传统PSV模式比较,Noisy PSV模式下患者潮气量的变异性明显增加,变化范围更大,人机不同步事件发生少,人机协调性更佳。
[Abstract]:Chronic obstructive pulmonary disease (pulmonary) is one of the most common respiratory diseases, which has high morbidity and mortality.In addition to drug therapy, invasive mechanical ventilation also plays an important role in the treatment of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure in patients with chronic obstructive pulmonary disease.Invasive mechanical ventilation enables the patient to resume spontaneous breathing after the disease is under control, thus allowing the patient to disengage from the ventilator smoothly. This process is usually difficult, and the patient's man-machine coordination is poor during treatment, which can lead to difficulty in weaning and prolonging the treatment time.To a certain extent, the patient increased the financial burden.Studies have shown that the breathing frequency, tidal volume, and inspiratory time of the body in a healthy and calm state are not fixed, but variable.At present, a new type of ventilator-variable pressure support ventilation (Noisy pressure support ventilation) has emerged. The application of this new model in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) needs further study.Objective: to investigate the safety and feasibility of the application of variant pressure support ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease with respiratory failure, and to compare it with the traditional PSV model.Methods: a total of 30 patients with AECOPD respiratory failure who were admitted to ricu and underwent invasive mechanical ventilation were collected. The clinical data of the patients were recorded, and the patients' transition from controlled ventilation to spontaneous respiration was recorded.According to the random sequence, PSV and Noisy PSV were given ventilation for 2 hours respectively. The baseline level and vital signs, gas exchange, hemodynamics and respiratory mechanics were recorded and analyzed statistically.Results: the study data showed that all patients were tolerated with traditional PSV and Noisy PSV without significant adverse reactions and discomfort.Heart rate, mean arterial pressure, respiratory rate, blood gas analysis PH value, partial pressure of carbon dioxide, partial pressure of oxygen, oxygenation index and blood lactate were compared between the two models.Compared with the traditional PSV model, the coefficient of variation of tidal volume in the Noisy PSV model was significantly higher than that in the conventional PSV model (12.1 卤8.2%vs.Noisy PSV 23.5 卤7.3).In the Noisy PSV model, the maximum tidal volume was significantly higher than that in the traditional PSV model (12.0 卤4.1 mL/kg vs.Noisy PSV 14.4 卤2.9 mL / kg P0.05), and the lowest tidal volume was significantly lower than that in the traditional PSV model (5.5 卤1.6 mL/kg vs.Noisy PSV 3.2 卤0.9 mL / kg / kg P 0.05).At the same time, in the course of applying two different modes of ventilation, the number of one-hour man-machine asynchronous events were observed and recorded. It can be seen that the occurrence of man-machine asynchronous events in Noisy PSV mode is lower than that in PSV mode.Conclusion the short-term application of the: Noisy PSV model in patients with AECOPD respiratory failure is safe and feasible.Compared with the traditional PSV model, the variability of tidal volume of patients in Noisy PSV model was significantly increased, the range of variation was larger, the occurrence of man-machine asynchronous events was less, and the human-computer coordination was better.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R563.8

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