Chang Suchi, Shi Jindong, Fu Cuiping, Wu Xu, Li Shanqun
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2016 May 17;11:1023-9. doi: 10.2147/COPD.S99156. eCollection 2016.
COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects.
We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure.
Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation - volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2-4 hours and 48 hours.
Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2-4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2-4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2-4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05).
Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation - volume control.
慢性阻塞性肺疾病（COPD）是全球第三大致死原因。COPD急性加重可能导致呼吸衰竭，需要入住重症监护病房并进行机械通气。因COPD急性加重而需要机械通气的重症监护病房患者的死亡率高于其他住院患者。尽管机械通气是针对这些情况最有效的干预措施，但有创通气技术产生的效果却不尽相同。
我们评估了压力调节容量控制（PRVC）通气对老年呼吸衰竭COPD患者的治疗效果及对肺气压伤的预防作用。
39例插管患者分为试验组和对照组，分别采用PRVC和同步间歇指令通气-容量控制方法进行治疗。在2 - 4小时及48小时监测生命体征、呼吸力学和动脉血气分析。
两组患者的pH值、氧分压（PaO2）、吸入氧分数与PaO2的比值均迅速改善，二氧化碳分压（PaCO2）水平降低。试验组2 - 4小时的pH值低于对照组，PaCO2水平高于对照组（两者均P<0.05）；48小时后，血气分析显示各项指标均无统计学差异（P>0.05）。治疗2 - 4小时及48小时期间两组的生命体征均无统计学差异（P>0.05）。试验组机械通气2 - 4小时及48小时后的吸气峰压水平显著低于对照组（P<0.05），而其他变量在两组间无显著差异（P>0.05）。
在老年呼吸衰竭COPD患者中，应用PRVC可使动脉血气分析迅速改善，同时保持较低的吸气峰压。PRVC可降低肺气压伤风险，使其成为比同步间歇指令通气-容量控制更安全的保护性通气模式。
