中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
2期
102-105
,共4页
罗建宇%王晓源%蔡天斌%蒋文芳
囉建宇%王曉源%蔡天斌%蔣文芳
라건우%왕효원%채천빈%장문방
心肺复苏%呼吸机%潮气量%气道高压
心肺複囌%呼吸機%潮氣量%氣道高壓
심폐복소%호흡궤%조기량%기도고압
Cardiopulmonary resuscitation%Ventilator%Volume tidal%Airway pressure
目的 研究持续胸外心脏按压时设置呼吸机不同潮气量(VT)与气道高压报警值对心肺复苏(CPR)效果的影响.方法 将重症医学科中40例呼吸、心搏骤停患者按随机数字表法均分为小VT通气组与常规VT通气组.两组均采用容量控制模式,小VT通气组CPR开始后呼吸机VT设置为6～7 ml/kg,高压报警值由40 cm H2O(1 cm H2O=0.098 kPa)上调至60 cm H2O；常规VT通气组CPR开始后VT值和高压报警值均保持不变(VT8 ～ 12 ml/kg,高压报警值40 cm H2O).观察对比CPR过程中呼吸机实测VT、吸气峰压(PIP),10 min、30 min时血气分析和血乳酸,以及并发症发生情况.结果 CPR 10 min后小VT通气组动脉血气分析中的5项指标[pH值、血氧分压(PaO2,mm Hg,1 mm Hg=0.133 kPa)、血二氧化碳分压(PaCO2,mm Hg)、HCO3-(mmol/L)、血氧饱和度(SaO2)]及血乳酸(mmol/L)均优于常规VT通气组(pH值:7.21 ±0.09比7.13±0.07,PaO2:45.35±5.92比40.70±4.70,PaCO2:57.10±7.59比61.60±5.47,HCO3-:18.50±3.50比14.75±2.65,SaO2:0.796±0.069比0.699±0.066,乳酸:7.07±1.60比8.13±1.56,均P＜0.05).小VT通气组复苏成功率较常规VT通气组高(45％比15％,P＜0.05)；PIP(cm H2O)较常规VT通气组低(37.25±7.99比42.70±7.40,P＜ 0.05)；两组均未发现气压伤.结论 CPR时呼吸机设置小VT(6～7 ml/kg)并适当上调气道高压报警值比常规VT通气方法效果更好,且气压伤发生率未见明显增加.
目的 研究持續胸外心髒按壓時設置呼吸機不同潮氣量(VT)與氣道高壓報警值對心肺複囌(CPR)效果的影響.方法 將重癥醫學科中40例呼吸、心搏驟停患者按隨機數字錶法均分為小VT通氣組與常規VT通氣組.兩組均採用容量控製模式,小VT通氣組CPR開始後呼吸機VT設置為6～7 ml/kg,高壓報警值由40 cm H2O(1 cm H2O=0.098 kPa)上調至60 cm H2O；常規VT通氣組CPR開始後VT值和高壓報警值均保持不變(VT8 ～ 12 ml/kg,高壓報警值40 cm H2O).觀察對比CPR過程中呼吸機實測VT、吸氣峰壓(PIP),10 min、30 min時血氣分析和血乳痠,以及併髮癥髮生情況.結果 CPR 10 min後小VT通氣組動脈血氣分析中的5項指標[pH值、血氧分壓(PaO2,mm Hg,1 mm Hg=0.133 kPa)、血二氧化碳分壓(PaCO2,mm Hg)、HCO3-(mmol/L)、血氧飽和度(SaO2)]及血乳痠(mmol/L)均優于常規VT通氣組(pH值:7.21 ±0.09比7.13±0.07,PaO2:45.35±5.92比40.70±4.70,PaCO2:57.10±7.59比61.60±5.47,HCO3-:18.50±3.50比14.75±2.65,SaO2:0.796±0.069比0.699±0.066,乳痠:7.07±1.60比8.13±1.56,均P＜0.05).小VT通氣組複囌成功率較常規VT通氣組高(45％比15％,P＜0.05)；PIP(cm H2O)較常規VT通氣組低(37.25±7.99比42.70±7.40,P＜ 0.05)；兩組均未髮現氣壓傷.結論 CPR時呼吸機設置小VT(6～7 ml/kg)併適噹上調氣道高壓報警值比常規VT通氣方法效果更好,且氣壓傷髮生率未見明顯增加.
목적 연구지속흉외심장안압시설치호흡궤불동조기량(VT)여기도고압보경치대심폐복소(CPR)효과적영향.방법 장중증의학과중40례호흡、심박취정환자안수궤수자표법균분위소VT통기조여상규VT통기조.량조균채용용량공제모식,소VT통기조CPR개시후호흡궤VT설치위6～7 ml/kg,고압보경치유40 cm H2O(1 cm H2O=0.098 kPa)상조지60 cm H2O；상규VT통기조CPR개시후VT치화고압보경치균보지불변(VT8 ～ 12 ml/kg,고압보경치40 cm H2O).관찰대비CPR과정중호흡궤실측VT、흡기봉압(PIP),10 min、30 min시혈기분석화혈유산,이급병발증발생정황.결과 CPR 10 min후소VT통기조동맥혈기분석중적5항지표[pH치、혈양분압(PaO2,mm Hg,1 mm Hg=0.133 kPa)、혈이양화탄분압(PaCO2,mm Hg)、HCO3-(mmol/L)、혈양포화도(SaO2)]급혈유산(mmol/L)균우우상규VT통기조(pH치:7.21 ±0.09비7.13±0.07,PaO2:45.35±5.92비40.70±4.70,PaCO2:57.10±7.59비61.60±5.47,HCO3-:18.50±3.50비14.75±2.65,SaO2:0.796±0.069비0.699±0.066,유산:7.07±1.60비8.13±1.56,균P＜0.05).소VT통기조복소성공솔교상규VT통기조고(45％비15％,P＜0.05)；PIP(cm H2O)교상규VT통기조저(37.25±7.99비42.70±7.40,P＜ 0.05)；량조균미발현기압상.결론 CPR시호흡궤설치소VT(6～7 ml/kg)병괄당상조기도고압보경치비상규VT통기방법효과경호,차기압상발생솔미견명현증가.
Objective To investigate the setting of ventilator volume tidal (VT) and airway pressure alarm threshold during cardiopulmonary resuscitation (CPR) by continuous extra-sternum heart compression.Methods Forty cases with respiration and cardiac arrest in the department of critical care medicine were randomly divided into low VT ventilation group and conventional VT group.Both groups were given the volume control mode.In the low VT ventilation group,VT was set on 6-7 ml/kg,and high pressure alarm threshold was adjusted to 60 cm H2O (1 cm H2O =0.098 kPa) by the conventional 40 cm H2O during CPR.In the conventional VT group,VT and high pressure alarm threshold were set at 8-12 ml/kg and 40 cm H2O,respectively.Real-time actual VT,peak inspiratory pressure (PIP),and arterial blood gas test,blood lactic acid at 10 minutes and 30 minutes after CPR were observed.Results At 10 minutes after CPR,in the low VT ventilation group,arterial blood pH,arterial partial pressure of oxygen (PaO2,mm Hg,1 mm Hg =0.133 kPa),arterial partial pressure of carbon dioxide (PaCO2,mm Hg),HCO3-(mmol/L),arterial oxygen saturation (SaO2) and blood lactic acid (mmol/L) were better as compared with those in the conventional VT ventilation group (pH:7.21 ± 0.09 vs.7.13 ± 0.07,PaO2:45.35 ± 5.92 vs.40.70 ± 4.70,PaCO2:57.10 ± 7.59 vs.61.60 ± 5.47,HCO3-:18.50 ± 3.50 vs.14.75 ± 2.65,SaO2:0.796 ± 0.069 vs.0.699 ± 0.066,blood lactic acid:7.07 ± 1.60 vs.8.13 ± 1.56,all P＜0.05).The success rate of resuscitation in the low VT ventilation group was higher than that of the conventional VT ventilation group (45％ vs.15％,P＜0.05),and PIP (cm H2O) of low VT ventilation group was lower than that of the conventional VT group (37.25 ± 7.99 vs.42.70 ± 7.40,P＜0.05).In all the patients in both groups barotrauma did not occur.Conclusion The strategy of low ventilator VT (6-7 ml/kg) with appropriate elevation of airway pressure alarm threshold was better than that of conventional ventilation setting,with no increase in incidence of barotraumas during CPR.
