本文選題：變異性壓力支持通氣 + 慢性阻塞性肺疾病急性加重　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)是最為常見的呼吸系統(tǒng)疾病之一,它的發(fā)病率及病死率均較高,穩(wěn)定期患者可以通過(guò)部分藥物維持治療使病情得以控制,而對(duì)于慢性阻塞性肺疾病急性加重(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭的患者除了藥物治療外,有創(chuàng)機(jī)械通氣治療也起到了重要作用。有創(chuàng)機(jī)械通氣使疾病得以控制后,患者恢復(fù)自主呼吸,從而可以順利脫離呼吸機(jī),而這一過(guò)程通常較為困難,治療中患者人機(jī)協(xié)調(diào)性差,從而會(huì)導(dǎo)致脫機(jī)困難,延長(zhǎng)治療時(shí)間,一定程度上給患者加大了經(jīng)濟(jì)負(fù)擔(dān)。具研究表明,人體在健康平靜狀態(tài)下自主呼吸的呼吸頻率、潮氣量、以及吸氣時(shí)間不是固定不變的,是存在變異的。目前,呼吸機(jī)的一種新型模式——變異性壓力支持通氣(Noisy pressure support ventilation,Noisy PSV)出現(xiàn)了,這種新型模式在慢性阻塞性肺疾病急性加重患者的應(yīng)用情況,尚需進(jìn)一步研究。研究目的:探討變異性壓力支持通氣模式在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者中應(yīng)用的安全性及可行性,并與傳統(tǒng)PSV模式進(jìn)行對(duì)比。研究方法:收集因AECOPD呼吸衰竭入住RICU,行有創(chuàng)機(jī)械通氣的患者共30例,記錄患者的臨床資料,在患者由控制通氣過(guò)渡到自主呼吸后,依據(jù)隨機(jī)順序各給予PSV及Noisy PSV模式通氣治療2小時(shí),分別記錄基線水平及應(yīng)用兩種模式后的生命體征、氣體交換、血流動(dòng)力學(xué)及呼吸力學(xué)等相關(guān)指標(biāo),對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。研究結(jié)果:研究數(shù)據(jù)顯示,在應(yīng)用傳統(tǒng)PSV及Noisy PSV兩種模式下,所有患者均可耐受,沒(méi)有表現(xiàn)出明顯的不良反應(yīng)及不適。將兩種模式下患者的心率、平均動(dòng)脈壓、呼吸頻率、血?dú)夥治鯬H值、二氧化碳分壓、氧分壓、氧合指數(shù)、血乳酸等指標(biāo)進(jìn)行比較,差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P0.05)。相對(duì)于傳統(tǒng)PSV模式,Noisy PSV模式下潮氣量的變異系數(shù)(CVVT)明顯升高(PSV 12.1±8.2%vs.Noisy PSV 23.5±7.3%,P0.05)。在Noisy PSV模式下,潮氣量的最高值明顯高于傳統(tǒng)PSV模式(PSV 12.0±4.1 mL/kg vs.Noisy PSV 14.4±2.9 m L/kg,P0.05),潮氣量最低值明顯低于傳統(tǒng)PSV模式(PSV 5.5±1.6 mL/kg vs.Noisy PSV 3.2±0.9 mL/kg,P0.05),差異具有統(tǒng)計(jì)學(xué)意義。同時(shí),在應(yīng)用兩種不同模式通氣過(guò)程中,分別觀察1小時(shí)人機(jī)不同步事件發(fā)生數(shù)量并記錄,可見應(yīng)用Noisy PSV模式時(shí)的人機(jī)不同步事件的發(fā)生低于應(yīng)用PSV模式(Noisy PSV 5(4,6)次/h vs.PSV 12(10,13)次/h,P0.05)。研究結(jié)論:Noisy PSV模式在AECOPD呼吸衰竭患者中的短期應(yīng)用安全可行。與傳統(tǒng)PSV模式比較,Noisy PSV模式下患者潮氣量的變異性明顯增加,變化范圍更大,人機(jī)不同步事件發(fā)生少,人機(jī)協(xié)調(diào)性更佳。
[Abstract]:Chronic obstructive pulmonary disease (pulmonary) is one of the most common respiratory diseases, which has high morbidity and mortality.In addition to drug therapy, invasive mechanical ventilation also plays an important role in the treatment of acute exacerbation of chronic obstructive pulmonary disease with respiratory failure in patients with chronic obstructive pulmonary disease.Invasive mechanical ventilation enables the patient to resume spontaneous breathing after the disease is under control, thus allowing the patient to disengage from the ventilator smoothly. This process is usually difficult, and the patient's man-machine coordination is poor during treatment, which can lead to difficulty in weaning and prolonging the treatment time.To a certain extent, the patient increased the financial burden.Studies have shown that the breathing frequency, tidal volume, and inspiratory time of the body in a healthy and calm state are not fixed, but variable.At present, a new type of ventilator-variable pressure support ventilation (Noisy pressure support ventilation) has emerged. The application of this new model in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) needs further study.Objective: to investigate the safety and feasibility of the application of variant pressure support ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease with respiratory failure, and to compare it with the traditional PSV model.Methods: a total of 30 patients with AECOPD respiratory failure who were admitted to ricu and underwent invasive mechanical ventilation were collected. The clinical data of the patients were recorded, and the patients' transition from controlled ventilation to spontaneous respiration was recorded.According to the random sequence, PSV and Noisy PSV were given ventilation for 2 hours respectively. The baseline level and vital signs, gas exchange, hemodynamics and respiratory mechanics were recorded and analyzed statistically.Results: the study data showed that all patients were tolerated with traditional PSV and Noisy PSV without significant adverse reactions and discomfort.Heart rate, mean arterial pressure, respiratory rate, blood gas analysis PH value, partial pressure of carbon dioxide, partial pressure of oxygen, oxygenation index and blood lactate were compared between the two models.Compared with the traditional PSV model, the coefficient of variation of tidal volume in the Noisy PSV model was significantly higher than that in the conventional PSV model (12.1 鹵8.2%vs.Noisy PSV 23.5 鹵7.3).In the Noisy PSV model, the maximum tidal volume was significantly higher than that in the traditional PSV model (12.0 鹵4.1 mL/kg vs.Noisy PSV 14.4 鹵2.9 mL / kg P0.05), and the lowest tidal volume was significantly lower than that in the traditional PSV model (5.5 鹵1.6 mL/kg vs.Noisy PSV 3.2 鹵0.9 mL / kg / kg P 0.05).At the same time, in the course of applying two different modes of ventilation, the number of one-hour man-machine asynchronous events were observed and recorded. It can be seen that the occurrence of man-machine asynchronous events in Noisy PSV mode is lower than that in PSV mode.Conclusion the short-term application of the: Noisy PSV model in patients with AECOPD respiratory failure is safe and feasible.Compared with the traditional PSV model, the variability of tidal volume of patients in Noisy PSV model was significantly increased, the range of variation was larger, the occurrence of man-machine asynchronous events was less, and the human-computer coordination was better.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9;R563.8

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