中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
6期
29-31
,共3页
呼吸,人工%呼吸力学%肺水肿%适应性支持通气
呼吸,人工%呼吸力學%肺水腫%適應性支持通氣
호흡,인공%호흡역학%폐수종%괄응성지지통기
Respiration,artificial%Respiratory mechanics%Pulmonary edema%Adaptive support ventilation
目的 比较两种肺保护通气模式在重症创伤性湿肺时施行肺保护通气策略中的临床意义.方法 将92例重症创伤性湿肺患者按随机数字表法分为适应性支持通气(ASV)组和压力型同步间歇指令通气(P-SIMV)+压力支持通气(PSV)组,每组46例,比较两组患者机械通气后30 min的心率、平均动脉压(MAP)、pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaC O2)、每分钟通气量、潮气量、总呼吸频率、气道峰压、平均气道压、气道闭合内压、肺顺应性.结果 机械通气后30 min,两组患者心率、MAP、pH值、PaO2、PaCO2、平均气道压、气道峰压、气道闭合内压比较差异均无统计学意义(P＞0.05),但ASV组潮气量、每分钟通气量、总呼吸频率、肺顺应性均较P-SIMV+PSV组明显改善[(692.6±38.6) ml比(558.5±25.6) ml、(8.9±1.7)L比(7.8±1.6)L、(16.3±3.3)次/min比(21.3±3.2)次/min、(42.15±5.28) ml/cmH2O(1 cmH2O=0.098 kPa)比(39.15±5.47) ml/cmH2O],差异均有统计学意义(P＜0.01或＜0.05).结论 对于重症创伤性湿肺患者在施行肺保护通气策略时,ASV可根据患者的呼吸力学状况自动调整吸气压力支持水平,提高潮气量、增加肺顺应性、降低呼吸频率,而对血流动力学和生命体征无明显影响.
目的 比較兩種肺保護通氣模式在重癥創傷性濕肺時施行肺保護通氣策略中的臨床意義.方法 將92例重癥創傷性濕肺患者按隨機數字錶法分為適應性支持通氣(ASV)組和壓力型同步間歇指令通氣(P-SIMV)+壓力支持通氣(PSV)組,每組46例,比較兩組患者機械通氣後30 min的心率、平均動脈壓(MAP)、pH值、動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaC O2)、每分鐘通氣量、潮氣量、總呼吸頻率、氣道峰壓、平均氣道壓、氣道閉閤內壓、肺順應性.結果 機械通氣後30 min,兩組患者心率、MAP、pH值、PaO2、PaCO2、平均氣道壓、氣道峰壓、氣道閉閤內壓比較差異均無統計學意義(P＞0.05),但ASV組潮氣量、每分鐘通氣量、總呼吸頻率、肺順應性均較P-SIMV+PSV組明顯改善[(692.6±38.6) ml比(558.5±25.6) ml、(8.9±1.7)L比(7.8±1.6)L、(16.3±3.3)次/min比(21.3±3.2)次/min、(42.15±5.28) ml/cmH2O(1 cmH2O=0.098 kPa)比(39.15±5.47) ml/cmH2O],差異均有統計學意義(P＜0.01或＜0.05).結論 對于重癥創傷性濕肺患者在施行肺保護通氣策略時,ASV可根據患者的呼吸力學狀況自動調整吸氣壓力支持水平,提高潮氣量、增加肺順應性、降低呼吸頻率,而對血流動力學和生命體徵無明顯影響.
목적 비교량충폐보호통기모식재중증창상성습폐시시행폐보호통기책략중적림상의의.방법 장92례중증창상성습폐환자안수궤수자표법분위괄응성지지통기(ASV)조화압력형동보간헐지령통기(P-SIMV)+압력지지통기(PSV)조,매조46례,비교량조환자궤계통기후30 min적심솔、평균동맥압(MAP)、pH치、동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaC O2)、매분종통기량、조기량、총호흡빈솔、기도봉압、평균기도압、기도폐합내압、폐순응성.결과 궤계통기후30 min,량조환자심솔、MAP、pH치、PaO2、PaCO2、평균기도압、기도봉압、기도폐합내압비교차이균무통계학의의(P＞0.05),단ASV조조기량、매분종통기량、총호흡빈솔、폐순응성균교P-SIMV+PSV조명현개선[(692.6±38.6) ml비(558.5±25.6) ml、(8.9±1.7)L비(7.8±1.6)L、(16.3±3.3)차/min비(21.3±3.2)차/min、(42.15±5.28) ml/cmH2O(1 cmH2O=0.098 kPa)비(39.15±5.47) ml/cmH2O],차이균유통계학의의(P＜0.01혹＜0.05).결론 대우중증창상성습폐환자재시행폐보호통기책략시,ASV가근거환자적호흡역학상황자동조정흡기압력지지수평,제고조기량、증가폐순응성、강저호흡빈솔,이대혈류동역학화생명체정무명현영향.
Objective To compare the clinical effective of two lung protective ventilation modes in severe traumatic wet lung (STWL) with lung ventilation strategy.Methods Ninety-two cases of STWL patients were divided into adaptive support ventilation (ASV) group and pressure type synchronous intermittent aeration instruction (P-SIMV) + pressure support ventilation (PSV) group with 46 cases by random number table method in each.Heart rate,mean arterial pressure (MAP),pH value,arterial blood oxygen partial pressure (PaO2),arterial bold carbondioxide partial pressure (PaCO2),minute ventilation,tidal volume,total respiratory frequency,airway peak pressure and mean airway pressure,airway closure pressure,and pulmonary compliance at 30 min after mechanical ventilation were compared between two groups.Results At 30 min after mechanical ventilation,heart rate,MAP,pH value,PaO2,PaCO2 and mean airway pressure,airway peak pressure and airway closure pressure between two groups had no statistical significance (P ＞0.05).But tidal volume,minute ventilation,total respiratory frequency,pulmonary compliance in ASV group were obviously improved compared with those in P-SIMV + PSV group [(692.6 ± 38.6) mlvs.(558.5±25.6)ml,(8.9± 1.7) Lvs.(7.8± 1.6) L,(16.3±3.3) times/min vs.(21.3±3.2)times/min,(42.15 ± 5.28) ml/cmH2O (1 cmH2O =0.098 kPa) vs.(39.15±5.47) ml/cmH2O] (P ＜ 0.01 or ＜0.05).Conclusion For patients with STWL in the lung protective ventilation strategy,ASV can automatically adjust the level of inspiratory pressure support according to the respiratory mechanics condition of the patients,improving tidal volume and pulmonary compliance,and reducing respiratory rate,which has no obvious effect on the hemodynamics and vital signs.
