摘要
目的 通过比较适应性支持通气（ASV）与同步间歇指令通气-压力支持通气（SIMV-PSV）模式在全身麻醉患者术后脱机过程中的应用,为临床寻找合适的脱机模式.方法 选取择期全身麻醉外科手术患者128例,按住院号尾数单双号分为ASV组（单号,62例）和SIMV-PSV组（双号,66例）,分别采用相应的通气模式.入ICU后记录患者丙泊酚用量、机械通气时间、气管插管时间,每一阶段的血气分析、血流动力学、呼吸力学指标,呼吸机报警次数和窒息通气次数.结果 128例患者均顺利拔管,ASV组丙泊酚用量、机械通气时间、气管插管时间均明显少于SIMV-PSV组[（1.13 ±0.33）mg/kg比（1.28±0.49） mg/kg、（169.8±36.5） min比（201.9±37.3） min、（197.2±38.9） min比（239.5±42.3）min],差异有统计学意义（P＜0.05）.两组各阶段心率、平均动脉压、中心静脉压、pH值、动脉血二氧化碳分压、氧合指数比较差异无统计学意义（P＞0.05）.第一阶段和第二阶段ASV组潮气量明显高于SIMV-PSV组[（543.6±72.3） ml比（489.5±68.7） ml、（513.9±65.7） ml比（462.8±61.7） ml],呼吸频率明显低于SIMV-PSV组[（13.2±3.6）次/min比（17.2±4.1）次/min、（15.1±3.1）次/min比（16.8±3.7）次/min],差异有统计学意义（P＜0.05）；第一阶段ASV组平均气道压和气道峰压明显低于SIMV-PSV组[（8.2±1.7） cm H2O（1 cm H2O=0.098 kPa）比（12.3±3.1） cm H2O、（16.2±2.9） cm H2O比（21.2±4.3） cm H2O],肺动态顺应性明显优于SIMV-PSV组[（64.8±12.3） ml/cm H2O比（52.6±13.5） ml/cm H2O],差异有统计学意义（P＜0.05）.ASV组呼吸机报警次数和窒息通气次数均明显少于SIMV-PSV组[（2.3±1.6）次比（5.1±1.9）次和（0.8±0.5）次比（1.6±0.8）次],差异有统计学意义（P＜0.05）.结论 ASV缩短了择期全身麻醉外科手术患者术后的机械通气时间,简化了临床医生对全身麻醉患者术后机械通气的管理,且安全性更高.
Objective To compare the different characteristics of adaptive support ventilation （ASV） and synchronized intermittent mandatory ventilation-pressure support ventilation （SIMV-PSV） mode in weaning patients after general anesthesia.Methods One hundred and twenty-eight patients received general anesthesia,ending in odd and even numbers by hospital number divided into ASV group （single number,62 cases） and SIMV-PSV group （double number,66 cases）.The propofol dosage,duration of mechanical ventilation,duration of intubation,ventilator alarms,ventilator settings manipulations and each stage of the blood gas analysis,hemodynamic,respiratory mechanics were recorded.Results One hundred and twenty-eight patients completed the extubation.The propofol dosage,duration of mechanical ventilation,duration of intubation in ASV group were significantly shorter than those in SIMV-PSV group [（1.13 ± 0.33）mg/kg vs.（1.28 ±0.49） mg/kg,（169.8±36.5） min vs.（201.9 ±37.3） min,（197.2 ±38.9） min vs.（239.5 ± 42.3） min,P 〈 0.05].There was no statistically significant difference in various stages of heart rate,mean arterial pressure,central venous pressure,pH,arterial carbon dioxide partial pressure,oxygenation index between two groups （P 〉0.05）.In the first and second stages,tidal volume in ASV group was significantly higher than that in SIMV-PSV group [（543.6 ± 72.3） ml vs.（489.5 ± 68.7） ml,（513.9 ± 65.7）ml vs.（462.8 ± 61.7） ml,P〈 0.05],respiratory rate in ASV group was significantly lower than that in SIMV-PSV group [（13.2 ± 3.6） times/min vs.（17.2 ±4.1） times/min,（15.1 ± 3.1） times/min vs.（16.8 ± 3.7）times/min,P 〈 0.05].In the first stage,the mean airway pressure and peak airway pressure in ASV group were significantly lower than those in SIMV-PSV group [（8.2 ± 1.7） cm H2O （1 cm H2O =0.098 kPa） vs.（12.3 ± 3.1） cm H2O,（16.2 ± 2.9） cm H2O vs.（21.2 ± 4.3） cm H2O,P 〈 0.05].The pulmonary dynamic compliance in ASV group was better than that in SIMV-PSV group [（64.8 ± 12.3） ml/cm H2O vs.（52.6 ±13.5） ml/cm H2O,P 〈 0.05].The ventilator alarms,ventilator settings manipulations in ASV group were significantly shorter than those in SIMV-PSV group [（2.3 ± 1.6） times vs.（5.1 ± 1.9） times,（0.8 ± 0.5） times vs.（1.6 ± 0.8） times,P 〈 0.05].Conclusion ASV weaning mode is safe and effective,which could accelerate the extubation and simplify the manipulation.
出处
《中国医师进修杂志》
2013年第21期19-23,共5页
Chinese Journal of Postgraduates of Medicine
关键词
呼吸
人工
麻醉
全身
适应性支持通气
脱机
Respiration, artificial
Anesthesia, general
Adaptive support ventilation
Weaning
