成比例辅助通气在呼吸机依赖极低出生体重儿中的临床应用

段江,何玺玉,郑天,孔祥永,封志纯

中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (06) : 401-405.

PDF(999 KB)
PDF(999 KB)
中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (06) : 401-405.
论著·临床研究

成比例辅助通气在呼吸机依赖极低出生体重儿中的临床应用

  • 段江,何玺玉,郑天,孔祥永,封志纯
作者信息 +

Clinical application of proportional assist ventilation in very low birth weight infants with ventilator dependence

  • DUAN Jiang, HE Xi-Yu, ZHENG Tian, KONG Xiang-Yong, FENG Zhi-Chun
Author information +
文章历史 +

摘要

目的:比较成比例辅助通气模式(PAV)和传统辅/控通气模式(A/C)对呼吸机依赖极低出生体重儿的生理学和呼吸力学影响。方法:46例呼吸机依赖极低出生体重儿随机分为PAV组和A/C组(每组23例)。PAV组以脱逸法设置阻力卸载增益,A/C组按常规通气方法调节,连续通气治疗3 d。每日在早、中、晚3个时间段分别连续监测观察30 min,比较两组患儿动脉血气分析结果、血氧饱和度(SPO2)、心率、血压、呼吸频率(RR)、平均气道压(MAP)、吸气峰压(PIP)、呼吸末正压(PEEP)、潮气量(VT)、每分通气量(MV)及氧合指数(OI)等指标。结果:血气分析指标中,PAV组PaO2、OI高于A/C组(均P0.05);呼吸力学指标中,PAV组PIP、MAP低于A/C组(均P0.05);血流动力学指标中,PAV组收缩压、舒张压变异度均低于A/C组(均P0.05)。结论:对呼吸机依赖极低出生体重儿,较之A/C模式,PAV模式能以更低的气道压维持机体气体交换正常,改善氧合,人机协同性更好。

Abstract

OBJECTIVE: To study the effect of proportional assist ventilation (PAV) on physiology and respiratory mechanics in very low birth weight (VLBW) infants with ventilator dependence by comparison with conventional assist/control (A/C) ventilation. METHODS: Forty-six infants with ventilator dependence were randomly divided into two groups according to the ventilation model: PAV (n=23) and A/C (n=23). The gain of resistive and elastic unloading was set based on the runway method in the PAV group. Ventilation parameters were set based on the conventional method in the A/C group. Infants were observed for 30 minutes three times per day for three consecutive days. Arterial gas analysis results, transcutaneous saturation of oxygen (SPO2), heart rate, blood pressure (BP), respiratory rate (RR), mean airway pressure (MAP), peak inspiratory pressure (PIP), tide volume (VT), minute volume (MV) and oxygenation index (OI), were compared between the two groups. RESULTS: Compared with the A/C group, PaO2 and OI in the PAV group were significantly higher while PIP and MAP were significantly lower. There were no significant differences in FiO2, SPO2, pH, PaCO2, PEEP, VT, MV and RR between the two groups. Although mean arterial blood pressure and heart rate in the PAV group were not different from the A/C group, beat-to-beat variabilities in systolic and diastolic arterial blood pressure were significantly lower in the PAV group than in the A/C group. CONCLUSIONS: PAV may safely maintain gas exchange at lower airway pressures compared with A/C ventilation in VLBW infants. It can also improve oxygenation and infant-ventilator synchronization.

关键词

成比例辅助通气 / 传统辅/控通气 / 极低出生体重儿

Key words

Proportional assist ventilation / Conventional assist/control ventilation / Very low birth weight infant

引用本文

导出引用
段江,何玺玉,郑天,孔祥永,封志纯. 成比例辅助通气在呼吸机依赖极低出生体重儿中的临床应用[J]. 中国当代儿科杂志. 2012, 14(06): 401-405
DUAN Jiang, HE Xi-Yu, ZHENG Tian, KONG Xiang-Yong, FENG Zhi-Chun. Clinical application of proportional assist ventilation in very low birth weight infants with ventilator dependence[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(06): 401-405
中图分类号: R722.1   

参考文献

[1]Younes M. Proportional assist ventilation, a new approach to ventilatory support. Theory[J]. Am Rev Respir Dis, 1992, 145(1): 114-120.

[2]Xirouchaki N, Kondili E, Klimathianaki M, Georgopoulos D. Is proportional-assist ventilation with load-adjustable gain factors a user-friendly mode?[J]. Intensive Care Med, 2009, 35(9): 1599-1603.

[3]叶俏,王辰,童朝晖,黄克武,姜超美,翁心植.比例辅助通气临床应用的方法学及疗效评价[J].中华结核和呼吸杂志,2000, 23(4):228-231.

[4]罗群,李缨,陈荣昌,郑则广,李寅环,秦朝辉.慢性阻塞性肺疾病急性发作期患者对比例辅助通气的生理反应[J].中华结核和呼吸杂志,2004, 27(11):743-747.

[5]Borghi-Silva A, Oliveira CC, Carrascosa CR, Maia J, Berton DC, Queiroga F Jr, et al. Respiratory muscle unloading improves leg muscle oxygenation during exercise in patients with COPD[J]. Thorax, 2008, 63(10): 910-915.

[6]Schulze A, Rieger-Fackeldey E, Gerhardt T, Claure N, Everett R, Bancalari E. Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease[J]. Neonatology, 2007, 92(1): 1-7.

[7]匡凤梧.长期机械通气[M]//喻文亮,钱素云,陶建平.小儿机械通气.上海:上海科学技术出版社,2012:310-377.

[8]Hummler H, Schulze A. New and alternative modes of mechanical ventilation in neonates[J]. Semin Fetal Neonatal Med, 2009, 14(1): 42-48.

[9]Gupta S, Sinha SK, Donn SM. Ventilatory management and bronchopulmonary dysplasia in preterm infants[J]. Semin Fetal Neonatal Med, 2009, 14(6): 367-373.

[10]Schulze A, Gerhardt T, Musante G, Schaller P, Claure N, Everett R, et al. Proportional assist ventilation in low birth weight infants with acute respiratory disease: a comparison to assist/control and conventional mechanical ventilation[J]. J Pediatr, 1999, 135(3): 339-344.

[11]刘郴州,刘东,郭青云,关浩锋,黄碧茵,上官明. 成比例辅助通气治疗早产儿呼吸窘迫综合征的疗效[J]. 实用儿科临床杂志,2010,25(2):121-122.

[12]武荣,周海燕,熊言佳,钱昊. 比例辅助通气模式在新生儿机械通气中的应用观察[J].中国医疗前沿,2009,4(4):49-50.

[13]Donn SM, Sinha SK. Minimising ventilator induced lung injury in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 2006, 91(3): 226-230.

[14]Tsuji M, Saul JP, du Plessis A, Eichenwald E, Sobh J, Crocker R, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants[J]. Pediatrics, 2000, 106(4):625-632.

PDF(999 KB)

Accesses

Citation

Detail

段落导航
相关文章

/