自适应分钟通气+智能触发通气模式在轻中度急性呼吸窘迫综合征患者中的临床应用

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目的:验证自适应分钟通气+智能触发(AMV+IntelliCycle)的新型智能通气模式在轻中度急性呼吸窘迫综合征(ARDS)患者中应用的安全性和有效性。方法:选择2018年2月至2019年2月锦州医科大学附属第一医院重症医学科收治的轻中度ARDS患者作为研究对象。按照随机数字表法将患者分为同步间歇指令通气+压力支持通气(SIMV+PSV)组和AMV+IntelliCycle组。所有患者入院后均给予呼吸机辅助通气、抗感染、镇痛镇静、营养支持以及原发病对症处理。两组患者均采用SV800型呼吸机进行机械通气。AMV+IntelliCycle组在设定分钟通气量(VE)、吸入氧浓度(FiOn 2)和呼气末正压(PEEP)后,呼吸机即开启全自动模式,VE百分比预设值为120%;SIMV+PSV组设置通气频率为12~20次/min,呼吸比1∶1~2,气道峰压(PIP)35~45 cmHn 2O(1 cmHn 2O=0.098 kPa),FiOn 2和PEEP设置与AMV+IntelliCycle组相同,触发流量设置为2 L/min。比较两组患者各项临床指标,其中主要结局指标包括机械通气时间、呼吸机报警次数和人工操作次数以及机械能;次要结局指标包括通气0、6、12、24、48、72、120 h的呼吸频率(RR)、VE、潮气量(VT)、PIP、口腔闭合压(P0.1)、静态顺应性(Cst)、呼吸功(WOB)和时间常数;同时观察通气前后血气分析指标。n 结果:研究期间共收治92例轻中度ARDS患者,排除因死亡、放弃治疗、意外拔管等中途退出研究者,最终共80例患者纳入分析,SIMV+PSV与AMV+IntelliCycle组各40例。①主要结局指标结果:与SIMV+PSV模式相比,AMV+IntelliCycle模式能明显缩短机械通气时间(h:106.35±55.03比136.50±73.78),显著减少呼吸机报警次数(次:10.35±5.87比13.93±6.87)和人工操作次数(次:4.25±2.01比6.83±3.75),同时明显降低机械能(J/min:12.88±4.67比16.35±5.04,均n P0.05),也不存在干预效应(n F值分别为1.459、0.514、0.923,均n P>0.05)。n 结论:AMV+IntelliCycle通气模式可以缩短轻中度ARDS患者的机械通气时间,降低机械能,并减少医护的工作量;应用AMV+IntelliCycle模式的ARDS患者PaCOn 2高于应用SIMV+PSV模式者。n “,”Objective:To verify the clinical safety and efficacy of new intelligent ventilation mode adaptive minute ventilation (AMV)+IntelliCycle ventilation in patients with mild-to-moderate acute respiratory distress syndrome (ARDS).Methods:The patients with mild-to-moderate ARDS, admitted to intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from February 2018 to February 2019, were enrolled in the study. The patients were divided into synchronous intermittent mandatory ventilation+pressure support ventilation (SIMV+PSV) group and AMV+IntelliCycle group according to the random number table method. All patients were given mechanical ventilation, anti-infection, analgesia and sedation, nutritional support and symptomatic treatment of primary disease after admission. SV800 ventilator was used for mechanical ventilation. In the AMV+IntelliCycle group, after setting the minute ventilation volume (VE), inhaled oxygen concentration (FiOn 2) and positive end expiratory pressure (PEEP), the ventilator was turned on the full-automatic mode, and the preset value of VE percentage was 120%. In the SIMV+PSV group, the ventilator parameters were set as follows: the ventilation frequency was 12-20 times/min, the inspiratory expiratory ratio was 1∶1-2, the peak inspiratory pressure (PIP) limit level was 35-45 cmHn 2O (1 cmHn 2O = 0.098 kPa), and the setting of FiOn 2 and PEEP was as the same as that of AMV+IntelliCycle group, the triggering flow was set to 2 L/min. All of the clinical parameters between the two groups were compared. The main outcomes were duration of mechanical ventilation, ventilator alarm times, manual operation times, and the mechanical power; the secondary outcomes were respiratory rate (RR), VE, tidal volume (VT), PIP, mouth occlusion pressure (P0.1), static compliance (Cst), work of breathing (WOB), and time constant at 0, 6, 12, 24, 48, 72, and 120 hours; and the blood gas analysis parameters of patients before and after ventilation were recorded.n Results:A total of 92 patients with mild-to-moderate ARDS were admitted during the study period, excluding those who quit the study due to death, abandonment of treatment, accidental extubation of tracheal intubation and so on. Eighty patients were finally enrolled in the analysis, with 40 patients in SIMV+PSV group and AMV+IntelliCycle group respectively. ① Results of main outcomes: compared with the SIMV+PSV mode, AMV+IntelliCycle ventilation mode could shorten the duration of mechanical ventilation (hours: 106.35±55.03 vs. 136.50±73.78), reduce ventilator alarm times (times: 10.35±5.87 vs. 13.93±6.87) and the manual operations times (times: 4.25±2.01 vs. 6.83±3.75), and decrease the mechanical power (J/min: 12.88±4.67 vs. 16.35±5.04, all n P 0.05) nor intervention effect ( n F values were 1.459, 0.514, 0.923, respectively, all n P > 0.05).n Conclusion:AMV+IntelliCycle ventilation mode can shorten the ventilation time of patients with mild-to-moderate ARDS, reduce mechanical power, and reduce the workload of medical care, but PaCOn 2 in the patients with AMV+IntelliCycle mode is higher than that in the patients with SIMV+PSV mode.n
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