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目的 建立比例辅助通气 (PAV)临床应用的方法 ,评价治疗慢性阻塞性肺疾病 (COPD)急性发作期患者的疗效 ,并与压力辅助通气 (PSV)比较。方法 选取 10例COPD机械通气患者 ,分别采用吸气阻断法和脱逸法设定参数。每例随机先后采用PAV或PSV ,PAV辅助水平分别设为 80 %、6 0 %和 4 0 %。同时监测主观感受、血流动力学、氧动力学和呼吸力学指标。结果 吸气阻断法与脱逸法设定的参数有很好的相关性r=0 92 8(P <0 0 1)。PAV不同的辅助水平只影响吸气峰压、呼吸机及患者做功 ,对通气指标无显著影响 (P >0 0 5 )。对循环功能稳定者 ,两组的血流动力学指标无显著差异 (P >0 0 5 ) ,氧合均保持在满意水平。在患者做功相同时 ,PAV组比PSV组潮气量有减小趋势 (P >0 0 5 ) ,动脉血PaCO2 显著增高 (P <0 0 5 ) ,吸气峰压显著减低 (P <0 0 1)。结论 采用脱逸法设定参数简单可靠。PAV是安全有效的通气模式 ,人机协调性好。在做功相同时 ,PAV比PSV吸气峰压降低 ,根据患者的需要保持相应的通气量。
Objective To establish a method for the clinical application of proportional Assisted Ventilation (PAV) in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and compare them with pressure assisted ventilation (PSV). Methods Totally 10 patients with mechanical ventilation of COPD were selected and their parameters were set by inhalation and withdrawal methods. In each case, PAV or PSV was used randomly, and PAV auxiliary levels were set as 80%, 60% and 40% respectively. Subjective feelings, hemodynamics, oxygen dynamics, and respiratory mechanics were also monitored. Results There was a good correlation between inhalation blockade and parameters set by the escape method (r = 0 92 8 (P <0.01). Different auxiliary levels of PAV only affect inspiratory peak pressure, ventilator and patient’s work, and have no significant effect on ventilation index (P> 0.05). For patients with stable circulation, there was no significant difference in hemodynamic parameters between the two groups (P> 0.05), and oxygenation was maintained at a satisfactory level. The tidal volume of PAV group was lower than that of PSV group (P> 0.05), PaCO2 of arterial blood group was significantly higher (P <0 05) and peak inspiratory pressure was significantly lower (P 0 01) ). Conclusion The desorption method is simple and reliable. PAV is a safe and effective ventilation mode, good man-machine coordination. When doing the same work, PAV than PSV inspiratory peak pressure decreased, according to the needs of patients to maintain the appropriate ventilation.