CAJ | 학술논문

目的监测呼吸机报警次数,评估自动变流速(AutoFlow)在容量控制通气中对患者的疗效和安全性.方法将接受Dr(a)ger Evita 4呼吸机预计机械通气时间＞2d的48例成年患者按随机数字表法分为两组,每组24例.对照组常规给予同步间歇指令通气(SIMV)模式,观察组给予SIMV辅助应用AutoFlow,均持续微量泵入咪达唑仑及芬太尼维持镇静Ramsay评分2～3分.记录呼吸机报警次数、血气分析结果及呼吸参数.结果两组患者机械通气5d内呼吸频率(RR)、潮气量(VT)、呼气末正压(PEEP)、吸入氧浓度(FiO2)、pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2),以及镇静剂使用剂量和使用时间差异均无统计学意义.所有患者总机械通气时间为164 d(3756 h),对照组78d(1812h),观察组86 d(1944 h);观察组机械通气时间[d,M(范围)]较对照组延长,但差异无统计学意义[3(1～15)比2(1～ 28),P＞0.05].所有患者共记录到23 843次呼吸机报警,平均6次/h;对照组记录到17 386次,平均9.6次/h;观察组记录到6457次,平均3.3次/h;观察组每小时的呼吸机报警次数少于对照组(P＜0.01),观察组气道压力报警次数明显少于对照组[122(8 ～ 1068)比565(13 ～ 1898),P＜0.01].两组患者机械通气1～5d序贯器官衰竭评分(SOFA)无明显差异.观察组有4例发生呼吸机相关性肺炎,无气胸发生,而对照组分别为8例和2例；观察组重症监护病房(ICU)病死率低于对照组,但差异无统计学意义(25.0％比37.5％,P＞0.05).结论 AutoFlow可安全用于容量控制通气模式,同时可以明显减少呼吸机报警的次数.
목적 감측호흡궤보경차수,평고자동변류속(AutoFlow)재용량공제통기중대환자적료효화안전성.방법 장접수Dr(a)ger Evita 4호흡궤예계궤계통기시간＞2d적48례성년환자안수궤수자표법분위량조,매조24례.대조조상규급여동보간헐지령통기(SIMV)모식,관찰조급여SIMV보조응용AutoFlow,균지속미량빙입미체서륜급분태니유지진정Ramsay평분2～3분.기록호흡궤보경차수、혈기분석결과급호흡삼수.결과 량조환자궤계통기5d내호흡빈솔(RR)、조기량(VT)、호기말정압(PEEP)、흡입양농도(FiO2)、pH치、동맥혈이양화탄분압(PaCO2)、동맥혈양분압(PaO2)、양합지수(PaO2/FiO2),이급진정제사용제량화사용시간차이균무통계학의의.소유환자총궤계통기시간위164 d(3756 h),대조조78d(1812h),관찰조86 d(1944 h);관찰조궤계통기시간[d,M(범위)]교대조조연장,단차이무통계학의의[3(1～15)비2(1～ 28),P＞0.05].소유환자공기록도23 843차호흡궤보경,평균6차/h;대조조기록도17 386차,평균9.6차/h;관찰조기록도6457차,평균3.3차/h;관찰조매소시적호흡궤보경차수소우대조조(P＜0.01),관찰조기도압력보경차수명현소우대조조[122(8 ～ 1068)비565(13 ～ 1898),P＜0.01].량조환자궤계통기1～5d서관기관쇠갈평분(SOFA)무명현차이.관찰조유4례발생호흡궤상관성폐염,무기흉발생,이대조조분별위8례화2례；관찰조중증감호병방(ICU)병사솔저우대조조,단차이무통계학의의(25.0％비37.5％,P＞0.05).결론 AutoFlow가안전용우용량공제통기모식,동시가이명현감소호흡궤보경적차수.
Objective To evaluate the efficacy and safety of automatic variable flow rate (AutoFlow) for volume control ventilation through monitoring the number of ventilator alarm.Methods Forty-eight adult patients receiving the Dr(a)ger Evita 4 ventilator with an expectation of more than 2 days duration were divided into two groups by randomly digital methods,each n =24.The patients in control group were received routinely mode with synchronized intermittent mandatory ventilation (SIMV),and the others in observation group were given SIMV and assist with AutoFlow.The midazolam and fentanyl was given to retain the Ramsay score 2-3 by continuous micro-pump.The ventilator alarm,blood gas analysis and respiratory function were recorded.Results There were no significant differences in respiratory rate (RR),tidal volume (VT),positive end-expiratory pressure (PEEP),fraction of inspired oxygen (FiO2),pH,arterial partial pressure of carbon dioxide (PaCO2),arterial partial pressure of oxygen (PaO2),oxygenation index (PaO2/FiO2),as well as sedative dose and time between two groups within 5 days of mechanical ventilation.Duration of mechanical ventilation in all patients was 164 days (3756 hours),and 78 days (1812 hours) in control group,86 days (1944 hours) iu observation group.The duration of mechanical ventilation [days,M (range)] in observation group was longer than that in control group [3 (1-15) vs.2 (1-28),P＞0.05].A total of 23 843 alarms were recorded,approximately 6 times/h,and 17 386 alarms in control group,averagely 9.6 times/h,6457 alarms in the observation group,averagely 3.3 times/h.The number of ventilator alarm in observation group was less than that in control group (P＜0.01).The number of airway pressure alarm in observation group was less than that in the control group [122(8-1068) vs.565(13-1898),P＜0.01].There was no significant difference in sequential organ failure assessment (SOFA) score within 5 days between the two sets of mechanical ventilation.In the observation group ventilator-associated pneumonia (VAP)was occurred in 4 cases,and no pneumothorax happened,while in the control group there were 8 cases and 2 cases respectively.The mortality rate in intensive care unit (ICU) in observation group was lower than that in control group,but there was no statistical difference (25.0％ vs.37.5％,P＞0.05).Conclusion AutoFlow is confirmed be safe for volume control ventilation mode,and could significantly reduce the alarm of ventilator.