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目的 观察比例辅助通气 (PAV)在临床初步应用疗效及其对急性呼吸衰竭患者呼吸、循环功能影响 ,并与间歇正压通气 (IPPV)、压力支持通气 (PSV)进行比较 ,为PAV临床广泛应用奠定基础。方法 对 10例急性呼衰患者先用IPPV模式通气 ,同时计算弹性阻力 (Ers)和粘性阻力 (Rrs) ,然后将模式改为PSV ,根据IPPV时数据设置支持压力 ,使得VT 与IPPV时大致相同。再将模式改为PAV ,根据PSV时的数据设置辅助百分比 ,使得潮气量 (VT)和峰压 (Ppeak)分别与PAV时大致相同。观察通气期间呼吸力学、血气和血流动力学的变化。结果 PAV和PSV、IPPV相比 ,在VT 相似的情况下 ,其Ppeak显著低 ,其患者呼吸功 (WOBp)、呼吸机呼吸功(WOBv)均较PSV、IPPV低 ;PAV与PSV相比 ,各血流动力学参数间无显著差异 ,PAV与IPPV相比 ,其CVP和PCWP较IPPV显著低。PAV与PSV相比 ,在Ppeak相似的情况下 ,PAV时VT、平均动脉压 (mBP)、心输出量 (CO)较PSV高 ,其平均肺动脉压 (mPAP)、WOBp较PSV低 ,其中WOBp显著低。结论 在临床急性呼衰患者中 ,PAV与PSV、IPPV相比 ,其气道压力低 ,呼吸功减少 ,对血流动力学影响较小。
Objective To observe the clinical efficacy of proportion-assisted ventilation (PAV) and its effects on respiration and circulatory function in patients with acute respiratory failure, and compare it with intermittent positive pressure ventilation (IPPV) and pressure support ventilation (PSV) Lay the foundation. Methods Ten patients with acute respiratory failure were ventilated with IPPV mode. Ers and viscous resistance (Rrs) were calculated at the same time. The mode was changed to PSV, and the support pressure was set according to the data of IPPV so that VT and IPPV were approximately the same . Then change the mode to PAV and set the assist percentage based on the PSV data so that the tidal volume (VT) and peak pressure (Ppeak) are approximately the same as those for PAV. Observe changes in respiratory mechanics, blood gas and hemodynamics during ventilation. Results Compared with PSV and IPPV, the Ppeak of PAV was significantly lower than that of PSV and IPPV, and WOBp and WOBv were lower than PSV and IPPV. Compared with PSV There was no significant difference in hemodynamic parameters between PAV and IPPV, and their CVP and PCWP were significantly lower than IPPV. Compared with PSV, PAV had higher mean arterial pressure (mBP) and cardiac output (CO) than PSV, mean pulmonary arterial pressure (mPAP), and WOBp lower than PSV in PAV with Ppeak similar low. Conclusions Among patients with acute respiratory failure, PAV has lower airway pressure and lower respiratory function compared with PSV and IPPV, and has less effect on hemodynamics.