适应性支持通气模式在颈髓损伤后呼吸衰竭患者中的应用
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摘要
目的观察适应性支持通气模式(ASV)在颈髓损伤后呼吸衰竭患者中的临床应用效果。方法采用前瞻性随机双盲对照研究的方法,选择2015年6月至2018年6月北京博爱医院收治的102例颈髓损伤后呼吸衰竭患者作为研究对象,按照随机平行分组法将其随机分为两组,对照组患者(n=51)给予同步间歇指令通气模式(SIMV),观察组患者(n=51)给予ASV模式;待两组患者呼吸平稳30 min后记录血流动力学指标、动脉血气分析结果以及呼吸力学指标,同时,采用视觉模拟评分法(VAS)评价患者的主观舒适度。结果两组患者的心率(71. 5±5. 3次/min vs. 72. 4±6. 2次/min)、平均动脉压(78. 3±10. 5 mm Hg vs. 77. 8±9. 8 mm Hg)、p H(7. 40±0. 1 vs. 7. 42±0. 2)、动脉血二氧化碳分压(39. 8±2. 8 mm Hg vs. 40. 2±2. 84 mm Hg)、动脉血氧分压(85. 7±5. 5 mm Hg vs. 83. 6±4. 2 mm Hg)比较,差异均无统计学意义(P> 0. 05);两组患者的每分钟通气量(8. 43±0. 65 L/min vs. 8. 39±0. 80 L/min)、潮气量(446. 8±14. 6ml vs. 442. 9±14. 65 ml)、呼吸频率(17. 58±2. 27次/min vs. 19. 58±2. 93次/min)、气道峰压(15. 33±1. 80 cmH2O vs. 15. 93±1. 64 cmH2O)、平均气道压(5. 34±0. 45 cmH2O vs. 5. 28±0. 49 cmH2O)比较,差异均无统计学意义(P> 0. 05);观察组患者的主观舒适度优于对照组(2. 7±1. 3分vs. 6. 5±1. 8分),差异具有统计学意义(P <0. 05)。结论ASV治疗颈髓损伤后呼吸衰竭的效果与SIMV基本相同,但ASV的舒适性更高。
Objective To observe the clinical effect of adaptive support ventilation( ASV) mode in patients with respiratory failure after cervical spinal cord injury. Methods A prospective randomized,double-blind,controlled study was performed in 102 patients with respiratory failure after cervical cord injury admitted to Beijing Pok Ai Hospital during June 2015 to June 2018. They were randomly divided into two groups according to the random parallel grouping method. Patients in control group( n = 51) were given with synchronous intermittent ventilation mode( SIMV),patients in observation group( n = 51) were given with ASV mode; after patients of these two groups were stable for 30 min,hemodynamic parameters and level of arterial blood gas were recorded. The results and respiratory mechanics were analyzed,and visually simulate the patient's subjective comfort by using visual analogue scale( VAS). Results HR( 71. 5 ± 5. 3 beats/min vs. 72. 4 ± 6. 2 beats/min),MAP( 78. 3± 10. 5 mmHg vs. 77. 8 ± 9. 8 mmHg),pH( 7. 40 ± 0. 1 vs. 7. 42 ± 0. 2),PaCO2( 39. 8 ± 2. 8 mmHg vs. 40. 2 ± 2. 84 mmHg) and PaO2( 85. 7 ± 5. 5 mm Hg vs. 83. 6 ± 4. 2 mm Hg)( P > 0. 05). MV( 8. 43 ± 0. 65 L/min vs. 8. 39 ± 0. 80 L/min) and VT( 446. 8 ± 14. 6 ml vs.442. 9 ± 14. 65 ml),RR( 17. 58 ± 2. 27 beats/min vs. 19. 58 ± 2. 93 beats/min),Ppeak( 15. 33 ± 1. 80 cm H2 O vs. 15. 93 ± 1. 64 cm H2 O),Pmean( 5. 34 ± 0. 45 cm H2 O vs. 5. 28 ± 0. 49 cm H2 O),no difference with statistical significance( P > 0. 05); subjective comfort in patients of observation group was better than that of control group( 2. 7 ± 1. 3 points vs. 6. 5 ± 1. 8 points),and the difference was statistically significant( P < 0. 05). Conclusion The effect of ASV on respiratory failure after cervical spinal cord injury is basically the same as SIMV,but the comfort of ASV is better.
Objective To observe the clinical effect of adaptive support ventilation( ASV) mode in patients with respiratory failure after cervical spinal cord injury. Methods A prospective randomized,double-blind,controlled study was performed in 102 patients with respiratory failure after cervical cord injury admitted to Beijing Pok Ai Hospital during June 2015 to June 2018. They were randomly divided into two groups according to the random parallel grouping method. Patients in control group( n = 51) were given with synchronous intermittent ventilation mode( SIMV),patients in observation group( n = 51) were given with ASV mode; after patients of these two groups were stable for 30 min,hemodynamic parameters and level of arterial blood gas were recorded. The results and respiratory mechanics were analyzed,and visually simulate the patient's subjective comfort by using visual analogue scale( VAS). Results HR( 71. 5 ± 5. 3 beats/min vs. 72. 4 ± 6. 2 beats/min),MAP( 78. 3± 10. 5 mmHg vs. 77. 8 ± 9. 8 mmHg),pH( 7. 40 ± 0. 1 vs. 7. 42 ± 0. 2),PaCO2( 39. 8 ± 2. 8 mmHg vs. 40. 2 ± 2. 84 mmHg) and PaO2( 85. 7 ± 5. 5 mm Hg vs. 83. 6 ± 4. 2 mm Hg)( P > 0. 05). MV( 8. 43 ± 0. 65 L/min vs. 8. 39 ± 0. 80 L/min) and VT( 446. 8 ± 14. 6 ml vs.442. 9 ± 14. 65 ml),RR( 17. 58 ± 2. 27 beats/min vs. 19. 58 ± 2. 93 beats/min),Ppeak( 15. 33 ± 1. 80 cm H2 O vs. 15. 93 ± 1. 64 cm H2 O),Pmean( 5. 34 ± 0. 45 cm H2 O vs. 5. 28 ± 0. 49 cm H2 O),no difference with statistical significance( P > 0. 05); subjective comfort in patients of observation group was better than that of control group( 2. 7 ± 1. 3 points vs. 6. 5 ± 1. 8 points),and the difference was statistically significant( P < 0. 05). Conclusion The effect of ASV on respiratory failure after cervical spinal cord injury is basically the same as SIMV,but the comfort of ASV is better.
引文
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[9]杜佩红.急性创伤性颈髓损伤病人呼吸衰竭危险因素分析[J].齐鲁医学杂志,2016,31(5):581-583.
[10] Arnal JM,Wysocki M,Novotni D,et al. Safety and efficacy of a fully closed-loop control ventilation(Intelli Vent-ASV)in sedated ICU patients with acute respiratory failure:a prospective randomized crossover study[J]. Intensive Care Med,2012,38(5):781-787.
[2]李强,朱曦,幺改琦,等.急性颈脊髓损伤患者早期死亡危险因素与防范措施[J].中国医刊,2009,44(5):26-28.
[3]朱烨,陈剑,何登伟,等.创伤性颈髓损伤早期并发呼吸衰竭风险及影响因素研究[J].中华全科医学,2016,14(11):1848-1850.
[4]朱烨,何登伟,陈剑,等.下颈椎损伤分类评分系统的临床应用[J].临床骨科杂志,2016,19(2):144-146.
[5]中华医学会重症医学分会.机械通气临床应用指南(2006)[J].中国危重病急救医学,2007,19(2):65-72.
[6]王玉兰,林海英,晏怡果,等.颈髓损伤患者术后呼吸衰竭的相关因素分析及预防性护理措施[J].中南医学科学杂志,2014,42(6):642-645.
[7]王辰.呼吸内科学[M].北京:人民卫生出版社,2008:215-218.
[8] Hasler RM,Exadaktylos AK,Bouamra O,et al. Epidemiology and predictors of cervical spine injury in adult major trauma patients:a multicenter cohort study[J]. J Trauma Acute Care Surg,2012,72(4):975-981.
[9]杜佩红.急性创伤性颈髓损伤病人呼吸衰竭危险因素分析[J].齐鲁医学杂志,2016,31(5):581-583.
[10] Arnal JM,Wysocki M,Novotni D,et al. Safety and efficacy of a fully closed-loop control ventilation(Intelli Vent-ASV)in sedated ICU patients with acute respiratory failure:a prospective randomized crossover study[J]. Intensive Care Med,2012,38(5):781-787.