适应性支持通气对COPD并发呼吸衰竭患者肺损伤及撤机成功率的影响

刘彬彬 贺志力 吴英萍

【摘要】 目的：观察适应性支持通气对慢性阻塞性肺疾病（COPD）并发呼吸衰竭患者肺损伤及撤机成功率的影响。方法：选取南昌市洪都中医院2020年8月—2023年8月收治的80例行机械通气治疗的COPD并发呼吸衰竭患者为对象，按随机数字表法分为A组（适应性支持通气模式）、B组（同步间歇指令+压力支持通气模式），各40例。比较两组血气指标、呼吸功能、急性生理与慢性健康状况评价Ⅱ（APACHEⅡ）评分、不良事件及撤机情况。结果：治疗后，两组动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、酸碱度（pH值）、APACHEⅡ评分比较，差异均无统计学意义（P>0.05）。A组一次性撤机成功率、达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）均高于B组，吸呼比（TI/TE）、呼吸频率（RR）均低于B组，差异均有统计学意义（P<0.05）。两组治疗期间不良事件发生率比较，差异无统计学意义（P>0.05）。结论：适应性支持通气用于COPD并发呼吸衰竭患者能更好地改善呼吸功能，提高一次性撤机成功率。

【关键词】 适应性支持通气 慢性阻塞性肺疾病 呼吸衰竭

Effect of Adaptive Support Ventilation on Pulmonary Injury and Weaning Success Rate in Patients with COPD and Respiratory Failure/LIU Binbin， HE Zhili， WU Yingping. //Medical Innovation of China， 2024， 21（14）： 0-057

[Abstract] Objective： To observe the effect of adaptive support ventilation on pulmonary injury and weaning success rate in patients with chronic obstructive pulmonary disease （COPD） complicated with respiratory failure. Method： A total of 80 patients with COPD and respiratory failure undergoing mechanical ventilation treatment in Nanchang Hongdu Hospital of TCM from August 2020 to August 2023 were selected as the subjects， and were devided into group A （adaptive support ventilation model） and group B （synchronous intermittent instruction + pressure supported ventilation model） according to the random number table method， with 40 cases in each group. The two groups were compared in terms of blood gas indicators， respiratory function， acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） score， adverse events and weaning status. Result： After treatment， there were no statistically significant differences in arterial partial pressure of oxygen （PaO2）， arterial partial pressure of carbon dioxide （PaCO2）， power of hydrogen （pH） and score of APACHEⅡ between the two groups （P>0.05）. The success rate of one-time weaning， peak time to reach ratio （TPTEF/TE） and peak volume to reach ratio （VPEF/VE） in group A were higher than those in group B， the inspiratory and expiratory ratio （TI/TE） and respiratory rate （RR） were lower than those in group B， the differences were statistically significant （P<0.05）. There was no statistically significant difference in the incidence of adverse events between both groups during treatment （P>0.05）. Conclusion： Adaptive support ventilation for patients with COPD complicated with respiratory failure can better improve the respiratory function and increase the success rate of weaning one-time.

[Key words] Adaptive support ventilation Chronic obstructive pulmonary disease Respiratory failure

First-author's address： Department of Critical Care Medicine， Nanchang Hongdu Hospital of TCM， Nanchang 330000， China

doi：10.3969/j.issn.1674-4985.2024.14.013

慢性阻塞性肺疾病（COPD）是我国疾病负担前五的疾病，患者以气道炎症为主要表现，我国40岁以上人群COPD发病率为13.7%[1-2]。COPD患者受外界刺激可恶化通气障碍，导致缺氧继而引发Ⅱ型呼吸衰竭，明显提升死亡风险[3-4]。针对COPD并发呼吸衰竭的患者需要尽快改善氧合，治疗以机械通气为主要手段，此法能在短时间内缓解患者通气不足引发的各种症状，平稳生命体征，为后续治疗准备条件[5-6]。机械通气有多种通气模式，各有特点，临床以同步间歇指令+压力支持通气模式和适应性支持通气模式常见，前者是人工设定参数并改善患者自主呼吸，后者是通过监测患者呼吸功能变化，调整呼吸机参数，改善患者呼吸功能，较传统同步间歇指令+压力支持通气模式，适应性支持通气模式智能化更高，操作更便捷[7-8]。关于……