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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
卢年芳, 郑瑞强, 林 华, 陈齐红, 於江泉, 邵 俊, 窦英茹.适应性支持通气模式在重症监护病房冠状动脉旁路移植术后患者中的应用[J].中华老年多器官疾病杂志,2012,11(1):40~45
适应性支持通气模式在重症监护病房冠状动脉旁路移植术后患者中的应用
Adaptive support ventilation in weaning patients after coronary artery bypass grafting in ICU
  
DOI:10.3724/SP.J.1264.2012.00011
中文关键词:  适应性支持通气; 同步间歇指令通气-压力支持通气; 冠状动脉旁路移植术; 脱机
英文关键词:adaptive support ventilation; synchronized intermittent mandatory ventilation-pressure support ventilation; coronary artery bypass grafting; weaning
基金项目:江苏省“333高层次人才培养工程”基金资助(2007-58)
作者单位E-mail
卢年芳, 郑瑞强, 林 华, 陈齐红, 於江泉, 邵 俊, 窦英茹 江苏省苏北人民医院, 扬州大学临床医学院重症监护病房, 扬州 225001 rqzh7@yahoo.com.cn 
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中文摘要:
      目的 通过比较适应性支持通气(ASV)和同步间歇指令通气-压力支持通气(SIMV-PSV)模式在冠状动脉旁路移植术后患者脱机中的应用, 为临床寻找更合适的脱机模式。方法 采用前瞻性临床研究方法, 纳入我院2007年1月~2010年6月期间体外循环下停跳冠状动脉旁路移植术后患者150例。冠状动脉旁路移植术后患者常规转入重症监护病房(ICU), 随机分为ASV组和SIMV-PSV组, 分别给予ASV和SIMV+PSV两种通气模式。实验共分为3个阶段, 并按标准的脱机程序脱机。若3个阶段均符合脱机条件, 则拔管。术后比较两组患者气管插管时间、机械通气时间、快通道的成功率、呼吸力学指标、血流动力学指标、呼吸机报警次数、人工操作次数等指标。 结果 共45例患者完成该研究, 其中ASV组22例, SIMV-PSV组23例。ASV组与SIMV-PSV组相比, 机械通气时间[(213.9±65.4)vs(309.2±71.2)min]、气管插管时间[(244.5±72.9)vs(338.3±85.6)min]、快通道的成功率(90.9% vs 60.9%)、呼吸机报警次数[(2.2±1.8)vs(4.2±2.1)次/min]、人工操作次数[(4.6±2.0)vs(9.3±4.3)次/min]均具有统计学差异(P<0.05)。ASV组与SIMV-PSV组的呼吸力学指标, 第一阶段的平均气道内压力[(7.5±1.1)vs(11.6±1.4)cmH2O]和肺组织动态顺应性[(65.3±12.3)vs(50.4±11.8)ml/cmH2O)组间具有统计学差异(P<0.05)。而血流动力学以及血气分析结果相比无统计学差异(P>0.05)。结论 ASV模式能加速气管插管的拔除, 简化操作, 为一个安全有效的脱机模式。
英文摘要:
      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 coronary artery bypass grafting and seek a more suitable weaning mode. Methods Prospective study enrolling 50 patients who received coronary artery bypass grafting from January 2007 to June 2010 was performed. After cardiac surgery, the patients were transferred to ICU and divided into ASV group and SIMV-PSV group randomly. Respiratory weaning progressed through 3 phases following the standard procedure and the patients were extubated if 3 phases all accorded with weaning condition. Duration of intubation, duration of mechanical ventilation, success rate of fast-track extubation, condition of breathing mechanics and hemodynamics, ventilator alarms, and ventilator settings manipulations before extubation were compared between the two groups. Results Forty-five patients including 22 patients in ASV group and 23 patients in SIMV-PSV group completed the study. Compared with SIMV-PSV group, parameters in ASV group, such as duration of mechanical ventilation[(213.9±65.4) vs (309.2±71.2)min], duration of intubation[(244.5±72.9) vs (338.3±85.6)min], success rate of fast-track extubation(90.9% vs 60.9%), ventilator alarms[(2.2±1.8) vs (4.2±2.1)times/min], ventilator settings manipulations[(4.6±2.0) vs (9.3±4.3)times/min] were significantly different(P<0.05). As for condition of breathing mechanics, mean airway pressure in ASV group was significantly lower than that in SIMV-PSV group[(7.5±1.1) vs (11.6±1.4)cmH2O, P<0.05] and pulmonary dynamic compliance in ASV group was better than that in SIMV-PSV group[(65.3±12.3) vs (50.4±11.8)ml/cmH2O, P<0.05]. There was no significant difference in hemodynamics and blood gas analysis between the two groups (P>0.05). Conclusion ASV weaning mode is safe and effective, which could accelerate the extubation and simplify the manipulation.
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