中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
10期
722-725
,共4页
心肺复苏%机械通气%方波%减速波%气道峰压
心肺複囌%機械通氣%方波%減速波%氣道峰壓
심폐복소%궤계통기%방파%감속파%기도봉압
Cardiopulmonary resuscitation%Mechanical ventilation%Square-wave%Decelerating-wave%Peak airway pressure
目的：观察心肺复苏（CPR）期间在胸外按压情况下的机械通气方式，探讨呼吸机送气流速模式选用方波（恒流）和减速波（递减波）对患者气道压力的影响。方法采用前瞻性自身配对设计方案，选择浙江省丽水市中心医院急诊科2011年1月至2013年2月序贯收治的40例CPR患者。使用伟康Eisprit呼吸机，常规设定的呼吸机工作其他参数不变，由同一医护人员给予患者的胸外按压进入稳定状态后，呼吸机流速模式先后使用方波和减速波，冻结时间-压力曲线后测量气道峰压的最高值并记录为一对数据。每例患者取不同按压者操作时的2对数据，40例患者共获得80对数据，通过自身配对t检验进行统计学分析。结果使用减速波时平均气道峰压最高值为（38.15±5.99）cmH2O（1 cmH2O＝0.098 kPa），比方波的（43.86±6.68）cmH2O减低了（5.71±1.98）cmH2O，且差异有统计学意义（t＝22.010，P＝0.000）。使用方波时有73.75%的患者气道峰压最高值会超过40 cmH2O，而使用减速波只有45.00%的患者气道峰压最高值会超过40 cmH2O。结论 CPR机械通气时，因使用减速波比方波能明显减低气道峰压，从而减轻气压伤的发生，减少呼吸机触发高压报警的概率，因而可提高呼吸机使用的依从性，故减速波是比方波更为合适的流速模式。
目的：觀察心肺複囌（CPR）期間在胸外按壓情況下的機械通氣方式，探討呼吸機送氣流速模式選用方波（恆流）和減速波（遞減波）對患者氣道壓力的影響。方法採用前瞻性自身配對設計方案，選擇浙江省麗水市中心醫院急診科2011年1月至2013年2月序貫收治的40例CPR患者。使用偉康Eisprit呼吸機，常規設定的呼吸機工作其他參數不變，由同一醫護人員給予患者的胸外按壓進入穩定狀態後，呼吸機流速模式先後使用方波和減速波，凍結時間-壓力麯線後測量氣道峰壓的最高值併記錄為一對數據。每例患者取不同按壓者操作時的2對數據，40例患者共穫得80對數據，通過自身配對t檢驗進行統計學分析。結果使用減速波時平均氣道峰壓最高值為（38.15±5.99）cmH2O（1 cmH2O＝0.098 kPa），比方波的（43.86±6.68）cmH2O減低瞭（5.71±1.98）cmH2O，且差異有統計學意義（t＝22.010，P＝0.000）。使用方波時有73.75%的患者氣道峰壓最高值會超過40 cmH2O，而使用減速波隻有45.00%的患者氣道峰壓最高值會超過40 cmH2O。結論 CPR機械通氣時，因使用減速波比方波能明顯減低氣道峰壓，從而減輕氣壓傷的髮生，減少呼吸機觸髮高壓報警的概率，因而可提高呼吸機使用的依從性，故減速波是比方波更為閤適的流速模式。
목적：관찰심폐복소（CPR）기간재흉외안압정황하적궤계통기방식，탐토호흡궤송기류속모식선용방파（항류）화감속파（체감파）대환자기도압력적영향。방법채용전첨성자신배대설계방안，선택절강성려수시중심의원급진과2011년1월지2013년2월서관수치적40례CPR환자。사용위강Eisprit호흡궤，상규설정적호흡궤공작기타삼수불변，유동일의호인원급여환자적흉외안압진입은정상태후，호흡궤류속모식선후사용방파화감속파，동결시간-압력곡선후측량기도봉압적최고치병기록위일대수거。매례환자취불동안압자조작시적2대수거，40례환자공획득80대수거，통과자신배대t검험진행통계학분석。결과사용감속파시평균기도봉압최고치위（38.15±5.99）cmH2O（1 cmH2O＝0.098 kPa），비방파적（43.86±6.68）cmH2O감저료（5.71±1.98）cmH2O，차차이유통계학의의（t＝22.010，P＝0.000）。사용방파시유73.75%적환자기도봉압최고치회초과40 cmH2O，이사용감속파지유45.00%적환자기도봉압최고치회초과40 cmH2O。결론 CPR궤계통기시，인사용감속파비방파능명현감저기도봉압，종이감경기압상적발생，감소호흡궤촉발고압보경적개솔，인이가제고호흡궤사용적의종성，고감속파시비방파경위합괄적류속모식。
Objective To observe the method of mechanical ventilation in the chest compressions during cardiopulmonary resuscitation (CPR),and to explore the influence of the flow pattern selection of square-wave and decelerating-wave on airway pressure of patients. Methods A prospective self-pairing study was conducted. Forty patients undergoing CPR admitted to Department of Emergency of Lishui City Central Hospital from January 2011 to February 2013 were enrolled. Using Respironics Eisprit ventilator,the working mode and parameters of ventilator were set reasonably according to previous research,while the chest compressions was performed in a stable state by the same doctor,. Each patient received different flow,waves,including square-wave and decelerating-wave,and the highest peak airway pressure was recorded as a pair of data when the time-pressure and time-flow waveform were frozen. Two pairs of data by different doctors were collected in each patient. Eighty pairs of data from 40 patients were collected for statistical analysis by paired t test. Results The highest peak airway pressure of decelerating-wave was (38.15± 5.99)cmH2O (1 cmH2O=0.098 kPa),which was (5.71±1.98)cmH2O lower than that of square wave 〔(43.86± 6.68)cmH2O〕with significantly statistical difference(t=22.010,P=0.000). 73.75%patients undergoing square wave with peak airway pressure over 40 cmH2O were found,but only 45.00% patients were found in decelerating-wave. Conclusion Because decelerating-wave used in mechanical ventilation during CPR can obviously reduce the peak airway pressure,the occurrence of barotrauma,and the probability of triggering high pressure ventilator alarm,and improve the compliance of ventilator,so decelerating-wave is more reasonable than square-wave.
