中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
9期
812-815
,共4页
呼吸窘迫综合征,成人%多处创伤%通气机,肺
呼吸窘迫綜閤徵,成人%多處創傷%通氣機,肺
호흡군박종합정,성인%다처창상%통기궤,폐
Acute respiratory distress syndrome,adult%Multiple trauma%Ventilatiors,pulmonary
目的 探讨适应性支持通气(adaptive support ventilation，ASV)模式加肺复张策略(lung recruitment maneuvers，LRM)与间歇正压通气(intermittent positive pressure ventilation，IPPV)模式对创伤合并ARDS患者的疗效。 方法 创伤合并ARDS患者28例，其中男18例，女10例；年龄19 ～48岁。先运用IPPV模式，设置潮气量(tidal volume，VT) 10 ml/kg，呼吸末正压(positive end-expiratory pressure，PEEP)O，送气流速32 L/min，吸入氧浓度60％。以上模式维持8h后随机在ASV+LRM和IPPV两种通气方式中选择一种通气模式继续机械通气，选择ASV+LRM通气模式时，ASV的分钟通气量设置应与IPPV的相同。通气时每一模式按0，5，10 cm H2O(1cm H2O=0.098 kPa)依次增加PEEP水平，每一PEEP水平的通气时间为60 min。4h后换到另一种通气模式，仍按0，5，10 cm H2O设置PEEP，每一PEEP水平的通气时间仍为60 min。其中使用ASV模式时加用LRM，即每一PEEP水平通气开始时短时间应用高水平持续气道正压(coutinuous positive airway pressure，CPAP)，压力设为45 cm H2O，屏气时间持续30 s，然后转为ASV模式，每个PEEP水平通气50 min时，用Swan-Ganz导管、心电监测仪、呼吸机监测记录血流动力学、呼吸力学和氧代谢数据。 结果 与IPPV模式比较，在同一PEEP水平下，ASV模式时气道峰值压(peak inflating pressure，PIP)(不包括在短时间使用LRM)、平台压(plateau pressure，Pplat)和肺内分流(Qs/Qt)均显著下降(P＜0.05)，氧合指数(PaO2/FiO2)和氧供(DO2)增加(P＜0.05)。两种通气模式的血流动力学数值比较差异无统计学意义(P＞0.05)。 结论 ASV+ LPS模式比IPPV模式更有利于创伤合并ARDS患者的通气治疗。
目的 探討適應性支持通氣(adaptive support ventilation，ASV)模式加肺複張策略(lung recruitment maneuvers，LRM)與間歇正壓通氣(intermittent positive pressure ventilation，IPPV)模式對創傷閤併ARDS患者的療效。 方法 創傷閤併ARDS患者28例，其中男18例，女10例；年齡19 ～48歲。先運用IPPV模式，設置潮氣量(tidal volume，VT) 10 ml/kg，呼吸末正壓(positive end-expiratory pressure，PEEP)O，送氣流速32 L/min，吸入氧濃度60％。以上模式維持8h後隨機在ASV+LRM和IPPV兩種通氣方式中選擇一種通氣模式繼續機械通氣，選擇ASV+LRM通氣模式時，ASV的分鐘通氣量設置應與IPPV的相同。通氣時每一模式按0，5，10 cm H2O(1cm H2O=0.098 kPa)依次增加PEEP水平，每一PEEP水平的通氣時間為60 min。4h後換到另一種通氣模式，仍按0，5，10 cm H2O設置PEEP，每一PEEP水平的通氣時間仍為60 min。其中使用ASV模式時加用LRM，即每一PEEP水平通氣開始時短時間應用高水平持續氣道正壓(coutinuous positive airway pressure，CPAP)，壓力設為45 cm H2O，屏氣時間持續30 s，然後轉為ASV模式，每箇PEEP水平通氣50 min時，用Swan-Ganz導管、心電鑑測儀、呼吸機鑑測記錄血流動力學、呼吸力學和氧代謝數據。 結果 與IPPV模式比較，在同一PEEP水平下，ASV模式時氣道峰值壓(peak inflating pressure，PIP)(不包括在短時間使用LRM)、平檯壓(plateau pressure，Pplat)和肺內分流(Qs/Qt)均顯著下降(P＜0.05)，氧閤指數(PaO2/FiO2)和氧供(DO2)增加(P＜0.05)。兩種通氣模式的血流動力學數值比較差異無統計學意義(P＞0.05)。 結論 ASV+ LPS模式比IPPV模式更有利于創傷閤併ARDS患者的通氣治療。
목적 탐토괄응성지지통기(adaptive support ventilation，ASV)모식가폐복장책략(lung recruitment maneuvers，LRM)여간헐정압통기(intermittent positive pressure ventilation，IPPV)모식대창상합병ARDS환자적료효。 방법 창상합병ARDS환자28례，기중남18례，녀10례；년령19 ～48세。선운용IPPV모식，설치조기량(tidal volume，VT) 10 ml/kg，호흡말정압(positive end-expiratory pressure，PEEP)O，송기류속32 L/min，흡입양농도60％。이상모식유지8h후수궤재ASV+LRM화IPPV량충통기방식중선택일충통기모식계속궤계통기，선택ASV+LRM통기모식시，ASV적분종통기량설치응여IPPV적상동。통기시매일모식안0，5，10 cm H2O(1cm H2O=0.098 kPa)의차증가PEEP수평，매일PEEP수평적통기시간위60 min。4h후환도령일충통기모식，잉안0，5，10 cm H2O설치PEEP，매일PEEP수평적통기시간잉위60 min。기중사용ASV모식시가용LRM，즉매일PEEP수평통기개시시단시간응용고수평지속기도정압(coutinuous positive airway pressure，CPAP)，압력설위45 cm H2O，병기시간지속30 s，연후전위ASV모식，매개PEEP수평통기50 min시，용Swan-Ganz도관、심전감측의、호흡궤감측기록혈류동역학、호흡역학화양대사수거。 결과 여IPPV모식비교，재동일PEEP수평하，ASV모식시기도봉치압(peak inflating pressure，PIP)(불포괄재단시간사용LRM)、평태압(plateau pressure，Pplat)화폐내분류(Qs/Qt)균현저하강(P＜0.05)，양합지수(PaO2/FiO2)화양공(DO2)증가(P＜0.05)。량충통기모식적혈류동역학수치비교차이무통계학의의(P＞0.05)。 결론 ASV+ LPS모식비IPPV모식경유리우창상합병ARDS환자적통기치료。
Objective To investigate the effect of adaptive support ventilation (ASV) plus lung recruitment maneuvers (LRM) and intermittent positive pressure ventilation (IPPV) on respiratory mechanics, hemodynamics and oxygen delivery in trauma patients combined with acute respiratory distress syndrome (ARDS). Methods Twenty-eight trauma patients combined with ARDS including 18 males and 10 females at age range of 19-48 years were mechanically ventilated by two modes, ie, IPPV and ASV + LPS.The patient was initially ventilated with IPPV for eight hours, with tidal volume (VT) of 10 ml/kg, PEEP = 0, oxygen delivery speed for 32 L/min and oxygen inhalation concentration of 60％.Then, one of ASV + LRM and IPPV was randomly selected for continual ventilation.There were three levels of positive end-expiratory pressure (PEEP,0,5 and 10 cmH2O).Each level of PEEP was maintained for 60 minutes.During the use of ASV + LRM, continuous positive airway pressure (CPAP) was at 45cmH2O and breath holding continued for 30 seconds.Then, the mode was turned to ASV and respiratory mechanics, hemodynamics and oxygen delivery were measured by using Swan-Ganz catheter, electrocardioscanner and ventilator when each level of PEEP was ventilated for 50 minutes. Results Compared with IPPV mode in the same level of PEEP, ASV + LRM mode had lower peak inflating pressure (PIP),airway plate pressure (Pplat) and intrapulmonary shunt (Qs/Qt) (P ＜ 0.05) but higher oxygenation index (PaO2/FiO2) and oxygen delivery (DO2) (P ＜ 0.05).There was no statistical difference in aspects of MAP, CI and SVRI during ventilation with IPPV and ASV (P ＞ 0.05). Conclusion ASV + LPS model is better than IPPV in ventilation for trauma patients combined with ARDS.
