CAJ | 학술논문

目的探讨不同机械通气模式及参数对胃内压力和消化功能的影响。方法选取因慢性阻塞性肺疾病伴呼吸衰竭行机械通气的40例患者，当病情稳定后，在PSV、SIMV、CMV 3种通气模式及0、5、10 cm H2O 3组呼气末正压（PEEP）参数下，监测患者的平均气道压（ITP）、胃内压（IGP）、胃排空时间、胃液pH值、胃液胆汁酸（TBA）并进行比较。结果（1）3种机械通气模式下，PSV组的ITP最低，CMV组最高，SIMV组居中；随着ITP的增加，IGP也基本呈增加趋势，故CMV对IGP的影响最大（P<0.01）。在不同PEEP值时，PEEP越大，ITP越高，对IGP的影响也越大（P<0.01）。（2）在3种通气模式和设置不同PEEP值时，ITP越高，胃排空时间越短，胃液TBA越高（P<0.05），而胃液pH值未观察到显著变化（P>0.05）。结论不同的机械通气模式和参数设置通过ITP对IGP、胃排空等产生不同程度的影响，选择合理的机械通气参数可在一定程度上改善消化功能。
목적탐토불동궤계통기모식급삼수대위내압력화소화공능적영향。방법선취인만성조새성폐질병반호흡쇠갈행궤계통기적40례환자，당병정은정후，재PSV、SIMV、CMV 3충통기모식급0、5、10 cm H2O 3조호기말정압（PEEP）삼수하，감측환자적평균기도압（ITP）、위내압（IGP）、위배공시간、위액pH치、위액담즙산（TBA）병진행비교。결과（1）3충궤계통기모식하，PSV조적ITP최저，CMV조최고，SIMV조거중；수착ITP적증가，IGP야기본정증가추세，고CMV대IGP적영향최대（P<0.01）。재불동PEEP치시，PEEP월대，ITP월고，대IGP적영향야월대（P<0.01）。（2）재3충통기모식화설치불동PEEP치시，ITP월고，위배공시간월단，위액TBA월고（P<0.05），이위액pH치미관찰도현저변화（P>0.05）。결론불동적궤계통기모식화삼수설치통과ITP대IGP、위배공등산생불동정도적영향，선택합리적궤계통기삼수가재일정정도상개선소화공능。
Objective To study the effect of different mechanical ventilation modes and parameters on intragastric pressure and digestive function. Methods Forty patients suffered respiratory failure were selected in the study. In different modes and parameters of mechanical ventilation, a multi-channel physiological signal recording device was used to monitor the intra-trachea pressure (ITP), intra-gastric pressure (IGP) synchronously, and the emptying time of stomach, pH value and total bile acid (TBA) concentration in gastric fluid of patients. Results (1) For three types of ventilation mode(PSV,SIMV and CMV), ITP was the lowest in group PSV, the highest was in group CMV and the middle was in group SIMV. With the in-crease in ITP, IGP was also increased. CMV was the most influencing factor for the IGP (P<0.01). In different PEEP values, the greater the PEEP, the higher the ITP. (2) Under mechanical ventilation support, when ITP increased, the emptying time of stomach decreased (P<0.01), the concentration of TBA increased (P<0.05). However, there was no significant change in pH value of gastric fluid (P>0.05). Conclusion Various mechanical ventilation modes and parameter settings induced differ-ent ITP, thereby affecting the IGP and gastric emptying. The digestive function can be promoted by choosing the appropriate mechanical ventilation mode and parameters.