【摘要】 目的:探讨适应性支持通气(ASV)和SIMV(同步间歇指令通气)在部分支持通气过程中对内源性PEEP(PEEPi)和呼吸功的影响。方法:30例有自主呼吸的危重症机械通气患者,在同样的分钟通气量和PEEP的设置下,先予以SIMV1(同步间歇指令通气)模式通气,45min后改为ASV模式通气,时间为45min,结束后再次回到SIMV2模式(参数设置与SIMV1一致),通气时间为45min。记录上述三个45min后的呼吸力学等参数。结果:ASV模式下的平台压下降明显,P<0.01;相对于SIMV1模式PEEPi的发生率为43.3%,ASV的发生率为20%,P<0.05;器械附加功(WOBimp)和吸气压力时间乘积(PTP)均小于SIMV1下的参数,P<0.01。结论:在部分支持通气过程中,ASV相对于SIMV,能明显改善高通气力学状态,有利于降低呼吸负荷和呼吸做功。更多还原

【Abstract】 Objective: To investigate the effect of adaptive support ventilation and SIMV on intrinsic PEEP (PEEPi) and work of breathing in partial ventilatory support. Methods: The 30 critical ill patients were treated with partial mechanical ventilation, initially in SIMV (SIMV1) for 45min. The patients were turned to ventilate with ASV, with settings identical to MV and PEEP of the SIMV1 period. After 45min, return to SIMV (SIMV2) for 45min, with setting identical to those the first SIMV period. The parameters of respiratory mechanics were obtained. Results: Compared with SIMV1, Pplate greatly increased(P < 0.01) during ASV. The incidence of PEEPi was significantly decreased during ASV (20%) as SIMV1(43.3%),P < 0.05. The median WOBimp and PTP were significantly lower on ASV compared to on SIMV1,P < 0.01. Conclusions: During partially support ventilation, ASV can improve dynamic pulmonary hyperinflation compared with SIMV, with benefit of diminishing inspiratory load.更多还原