平均容積保證壓力支持模式無創通氣對超重的慢性阻塞性肺疾病患者急性Ⅱ型呼吸衰竭的治療研究_《華西醫學》

作者：

李凱 , 練祥忠 , 沈劍 , 王君蘭 , 錢姣 , 孟曉蓉 , 黃曉珠

成都市第三人民醫院呼吸內科（成都，610031）;

關鍵詞：

平均容積保證壓力支持無創通氣超重慢性阻塞性肺疾病急性Ⅱ型呼吸衰竭

DOI：

10.7507/1002-0179.20130574

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目的　比較無創雙水平正壓通氣（BiPAP）平均容積保證壓力支持（AVAPS）模式與同步/時間控制（S/T）模式在肥胖的慢性阻塞性肺疾病（COPD）患者并發急性Ⅱ型呼吸衰竭中的治療作用。方法　選取2012年3月－2013年6月入院治療且體質量指數（BMI）＞25 kg/m2的COPD發生急性Ⅱ型呼吸衰竭患者36例，按數字隨機表法分為AVAPS組與S/T組。兩組的基礎治療相同，AVAPS組采用飛利浦偉康V60呼吸機BiPAP AVAPS模式進行無創通氣治療，S/T組采用相同機型BiPAP S/T模式治療。分別比較兩組患者治療1、6、24、72 h的格拉斯高昏迷（GCS）評分變化、血氣分析結果、呼吸機監測數據。結果　AVAPS組患者在最初治療的6 h內GCS評分高于S/T組[1 h：（13.2 ± 0.6）、（11.9 ± 0.6）分，P＜0.05；6 h：（13.8 ± 0.5）、（12.1 ± 0.6）分，P＜0.05]；24 h內的動脈血氣酸堿度pH值改善[1 h：7.31 ± 0.03、7.26 ± 0.02，P＜0.05；6 h：7.37 ± 0.05、7.31 ± 0.04，P＜0.05]；24 h：7.40 ± 0.04、7.33 ± 0.03，P＜0.05]及二氧化碳分壓下降[1 h：（65.2 ± 5.1）、（69.5 ± 4.1）mm Hg（1 mm Hg=0.133 kPa），P＜0.05；6 h：（61.4 ± 4.2）、（66.7 ± 4.3） mm Hg，P＜0.05；24 h：（58.2 ± 4.5）、（64.3 ± 5.4） mm Hg，P＜0.05）]優于S/T組，24 h內淺快呼吸指數低于S/T組[1 h：（35.2 ± 8.1）、（62.8 ± 13.2）次/（min·L），P＜0.05]；6 h（33.4 ± 7.8）、（54.8 ± 11.6）次/（min·L），P＜0.05]，同時，減少了額外的人工參數調整次數[3.4 ± 1.1、1.2 ± 0.6），P＜0.05] 結論　對超重的COPD合并急性Ⅱ型呼吸衰竭患者采用AVAPS模式進行無創通氣治療，較
S/T模式能更快地恢復意識水平，更快地降低血二氧化碳分壓、改善pH值，同時減少了呼吸治療師的人工操作次數。

引用本文： 李凱,練祥忠,沈劍,王君蘭,錢姣,孟曉蓉,黃曉珠. 平均容積保證壓力支持模式無創通氣對超重的慢性阻塞性肺疾病患者急性Ⅱ型呼吸衰竭的治療研究. 華西醫學, 2013, 28(12): 1809-1813. doi: 10.7507/1002-0179.20130574 復制

1.	Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: gold executive summary[J]. Am J Respir Crit Care Med, 2013, 187(4): 347-365.
2.	Garpestad E, Brennan J, Hill NS. Noninvasive ventilation for critical care[J]. Chest, 2007, 132: 711-720.
3.	Crisafulli E, Manni G, Kidonias M, et al. Subjective sleep quality during average volume assured pressure support (AVAPS) ventilation in patients with hypercapnic COPD: a physiological pilot study[J]. Lung, 2009, 187(5): 299-305.
4.	中華醫學會呼吸病學分會呼吸生理與重癥監護學組, 《中華結核和呼吸雜志》編輯委員會. 無創正壓通氣臨床應用專家共識[J]. 中華結核和呼吸雜志, 2009, 32(2): 86-98.
5.	Ramachandran K, McCusker C, Connors M, et al. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD[J]. Chron Respir Dis, 2008, 5(4): 205-209.
6.	Cao C, Wang R, Wang J, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis[J]. PLoS One, 2012, 7(8): e43892.
7.	Sava F, Laviolette L, Bernard S, et al. The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD[J]. BMC Pulm Med, 2010, 10(6): 55.
8.	Yeh F, Dixon AE, Marion S, et al. Obesity in adults is associated with reduced lung function in metabolic syndrome and diabetes: the Strong Heart Study[J]. Diabetes Care, 2011, 34(10): 2306-2313.
9.	Santamaria F, Montella S, Greco L, et al. Obesity duration is associated to pulmonary function impairment in obese subjects[J]. Obesity (Silver Spring), 2011, 19(8): 1623-1628.
10.	Hess DR. Patient-ventilator interaction during noninvasive ventilation[J]. Respir Care, 2011, 56(2): 153-165.
11.	Storre JH, Seuthe B, Fiechter R, et al. average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial[J]. Chest, 2006, 130(3): 815-821.
12.	Vagiakis E, Koutsourelakis I, Perraki E, et al. Average volume-assured pressure support in a 16-year-old girl with congenital central hypoventilation syndrome[J]. J Clin Sleep Med, 2010, 6(6): 609-612.
13.	Nava S, Ceriana P. Causes of failure of noninvasive mechanical ventilation[J]. Respir Care, 2004, 49(3): 295-303.
14.	Briones CKH, Briones CM, Chung SWM, et al. Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy[J]. BMC Pulm Med, 2013, 13(1): 12.
15.	Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial[J]. Thorax, 2012, 67(8): 727-734.

1. 　Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: gold executive summary[J]. Am J Respir Crit Care Med, 2013, 187(4): 347-365.
2. 　Garpestad E, Brennan J, Hill NS. Noninvasive ventilation for critical care[J]. Chest, 2007, 132: 711-720.
3. 　Crisafulli E, Manni G, Kidonias M, et al. Subjective sleep quality during average volume assured pressure support (AVAPS) ventilation in patients with hypercapnic COPD: a physiological pilot study[J]. Lung, 2009, 187(5): 299-305.
4. 　中華醫學會呼吸病學分會呼吸生理與重癥監護學組, 《中華結核和呼吸雜志》編輯委員會. 無創正壓通氣臨床應用專家共識[J]. 中華結核和呼吸雜志, 2009, 32(2): 86-98.
5. 　Ramachandran K, McCusker C, Connors M, et al. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD[J]. Chron Respir Dis, 2008, 5(4): 205-209.
6. 　Cao C, Wang R, Wang J, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis[J]. PLoS One, 2012, 7(8): e43892.
7. 　Sava F, Laviolette L, Bernard S, et al. The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD[J]. BMC Pulm Med, 2010, 10(6): 55.
8. 　Yeh F, Dixon AE, Marion S, et al. Obesity in adults is associated with reduced lung function in metabolic syndrome and diabetes: the Strong Heart Study[J]. Diabetes Care, 2011, 34(10): 2306-2313.
9. 　Santamaria F, Montella S, Greco L, et al. Obesity duration is associated to pulmonary function impairment in obese subjects[J]. Obesity (Silver Spring), 2011, 19(8): 1623-1628.
10. 　Hess DR. Patient-ventilator interaction during noninvasive ventilation[J]. Respir Care, 2011, 56(2): 153-165.
11. 　Storre JH, Seuthe B, Fiechter R, et al. average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial[J]. Chest, 2006, 130(3): 815-821.
12. 　Vagiakis E, Koutsourelakis I, Perraki E, et al. Average volume-assured pressure support in a 16-year-old girl with congenital central hypoventilation syndrome[J]. J Clin Sleep Med, 2010, 6(6): 609-612.
13. 　Nava S, Ceriana P. Causes of failure of noninvasive mechanical ventilation[J]. Respir Care, 2004, 49(3): 295-303.
14. 　Briones CKH, Briones CM, Chung SWM, et al. Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy[J]. BMC Pulm Med, 2013, 13(1): 12.
15. 　Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial[J]. Thorax, 2012, 67(8): 727-734.

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平均容積保證壓力支持模式無創通氣對超重的慢性阻塞性肺疾病患者急性Ⅱ型呼吸衰竭的治療研究

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