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目的评价适应性支持通气(ASV)模式与间歇正压通气(IPPV)模式在急性呼吸窘迫综合征(ARDS)患者中的效果。方法ARDS患者30例,年龄19-46岁,男18例,女12例,ASAⅢ或Ⅳ级。先应用IPPV模式,吸入氧浓度60％,PEEP为0,潮气量(VT)10ml／kg,吸呼比(I:E)1:2,维持8 h后随机选择换用ASV或继续IPPV通气模式,通气时依次按0、5、10 cm H2O增加PEEP,每一PEEP水平的通气时间为60 min,在同样的分钟通气量的设置下,4 h后更换另一种通气模式,仍按0、5、10 cm H2O增加PEEP,每一PEEP水平的通气时间为60 min。每个PEEP水平通气50 min时,用Swan-Ganz导管、心电监测仪、呼吸机监测记录血液动力学、呼吸力学和氧代谢数据。结果与IPPV模式比较,ASV模式下气道峰值压降低,肺动态顺应性(Cdyn)、动脉氧分压(PaO2)和氧供(DO2)增加(P<0．05)。两种通气模式的血液动力学参数比较差异无统计学意义(P>0．05)。结论ASV模式比IPPV模式更有利于ARDS患者的通气治疗。
Objective To evaluate the effect of adaptive support ventilation (ASV) and intermittent positive pressure ventilation (IPPV) on patients with acute respiratory distress syndrome (ARDS). Methods Thirty patients with ARDS aged 19-46 years, 18 males and 12 females, with ASA III or IV. The IPPV model was used to inhale oxygen concentration 60%, PEEP 0, tidal volume (VT) 10ml / kg and I / E ratio 1: 2. , Followed by ventilation 0,5,10 cm H2O increase PEEP, PEEP level of each ventilation time of 60 min, the same minute ventilation settings, 4 h after the replacement of another ventilation mode, still press 0, 5,10 cm H 2 O increased PEEP, and the ventilation time per PEEP was 60 min. Each PEEP level of ventilation 50 min, with Swan-Ganz catheter, ECG monitor, ventilator monitoring recorded hemodynamic, respiratory mechanics and oxygen metabolism data. Results Compared with IPPV model, peak airway pressure drop, pulmonary dynamic compliance (Cdyn), arterial oxygen pressure (PaO2) and oxygen supply (DO2) were increased in ASV model (P <0.05). There was no significant difference in hemodynamic parameters between the two ventilation modes (P> 0.05). Conclusions ASV model is more beneficial to ventilation therapy in patients with ARDS than IPPV model.