The Therapeutic Study of Average Volume Assured Pressure Support Noninvasive Ventilation in Overweight Chronic Obstructive Pulmonary Disease Patients with Acute Ventilatory Failure_West China Medical Journal

Authors：

LI Kai , LIAN Xiangzhong , SHEN Jian , WANG Junlan , QIAN Jiao , MENG Xiaorong , HUANG Xiaozhu.

Respiratory Department of Chengdu 3rd People’s Hospital, Chengdu, Sichuan 610031, P. R. China;

Corresponding author：

Keywords：

平均容积保证压力支持; 无创通气; 超重; 慢性阻塞性肺疾病; 急性Ⅱ型呼吸衰竭

DOI：

10.7507/1002-0179.20130574

Video：

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目的　比较无创双水平正压通气（BiPAP）平均容积保证压力支持（AVAPS）模式与同步/时间控制（S/T）模式在肥胖的慢性阻塞性肺疾病（COPD）患者并发急性Ⅱ型呼吸衰竭中的治疗作用。方法　选取2012年3月－2013年6月入院治疗且体质量指数（BMI）＞25 kg/m2的COPD发生急性Ⅱ型呼吸衰竭患者36例，按数字随机表法分为AVAPS组与S/T组。两组的基础治疗相同，AVAPS组采用飞利浦伟康V60呼吸机BiPAP AVAPS模式进行无创通气治疗，S/T组采用相同机型BiPAP S/T模式治疗。分别比较两组患者治疗1、6、24、72 h的格拉斯高昏迷（GCS）评分变化、血气分析结果、呼吸机监测数据。结果　AVAPS组患者在最初治疗的6 h内GCS评分高于S/T组[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内的动脉血气酸碱度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]及二氧化碳分压下降[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）]优于S/T组，24 h内浅快呼吸指数低于S/T组[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]，同时，减少了额外的人工参数调整次数[3.4 ± 1.1、1.2 ± 0.6），P＜0.05] 结论　对超重的COPD合并急性Ⅱ型呼吸衰竭患者采用AVAPS模式进行无创通气治疗，较
S/T模式能更快地恢复意识水平，更快地降低血二氧化碳分压、改善pH值，同时减少了呼吸治疗师的人工操作次数。

Citation： LI Kai,LIAN Xiangzhong,SHEN Jian,WANG Junlan,QIAN Jiao,MENG Xiaorong,HUANG Xiaozhu.. The Therapeutic Study of Average Volume Assured Pressure Support Noninvasive Ventilation in Overweight Chronic Obstructive Pulmonary Disease Patients with Acute Ventilatory Failure. West China Medical Journal, 2013, 28(12): 1809-1813. doi: 10.7507/1002-0179.20130574 Copy

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.	中华医学会呼吸病学分会呼吸生理与重症监护学组, 《中华结核和呼吸杂志》编辑委员会. 无创正压通气临床应用专家共识[J]. 中华结核和呼吸杂志, 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. 　中华医学会呼吸病学分会呼吸生理与重症监护学组, 《中华结核和呼吸杂志》编辑委员会. 无创正压通气临床应用专家共识[J]. 中华结核和呼吸杂志, 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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West China Medical Journal

The Therapeutic Study of Average Volume Assured Pressure Support Noninvasive Ventilation in Overweight Chronic Obstructive Pulmonary Disease Patients with Acute Ventilatory Failure

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