摘要
目的:探讨用理想体重代替实际体重设置机械通气初始参数,使机械通气更接近生理需要,以期降低再次调整呼吸机的比例。方法:将80例肺功能正常的患者随机分为两组,A组41例,B组39例,前瞻性研究在分别按8ml/kg实际体重(A 组)和8 mL/kg理想体重(B组)初始设定潮气量、呼吸频率为16次/分后,观察2组每分通气量、气道峰压、气道平均压、吸气流速、酸碱度(pH)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、标准碱剩余(SBE)的变化及是否需要再次调整机械通气参数。资料的统计分析由SPSS11.0完成,两组变量的计量资料进行独立样本的t检验。结果:初始设置呼吸机后,A组的每分通气量、pH、动脉血PaCO2、SBE分别为7.46±0.1、(33.9±4.3)mmHg、1.3±2.3,B组的pH、动脉血PaCO2、SBE分别为7.41±0.1、(37.5±4.5)mmHg、0.03±2.6,均P<0.05。两组需要再次调整呼吸机的比例为43.9%和20.5%,有显著差异(P<0.05)。需要再次调整呼吸机的患者,其调整后的潮气量按理想体重计算,为(8.2±0.8)ml/kg。结论:用理想体重设置初始潮气量可显著降低再次调整呼吸机的比例。对于肺功能正常的患者,将呼吸频率设为16次/分时,按8 ml/kg理想体重来设置初始的潮气量是适宜的。
Objective ：To investigate the initial setting of mechanical ventilation according to ideal bodyweight instead of actual bodyweight post cardiac operation, so that mechanical ventilation can reach the physiological demands and decrease the ratio of readjustment of mechanical ventilation.
Methods：A research was conducted in 80 patients with normal lung function post off pump coronary artery bypass （OPCAB） who were divided randomly into two groups, actual bodyweight group （ n = 41 ） and ideal bodyweight group （ n = 39 ）. The tidal volume was set as 8 ml/kg for actual bodyweight and 8 ml/kg for ideal bodyweight, respectively. The respiratory rate was set as 16 beats/minute. Data on minute volume, airway peak pressure, airway mean pressure, inspiration flow rate, arterial blood gas （pH, PaOz,PaCOz,SBE） and the need of readjusted mechanical ventilation were recorded. Statistical analysis was performed using SPSS11.0.
Results：There were no significante differences in terms of age, height and actual bodyweight of the two groups （P 〉 0. 05 ）. In actual bodyweight group, the means of pH, PaCO2, SBE were 7.46 ± 0. 1,33.9 ± 4. 3 and 1.3 ± 2. 3, respectively. In ideal bodyweight group,the means of pH, PaCO2, SBE were 7.41 ± 0. 1,37.5 ± 4. 5 and 0.03 ± 2. 6, respectively, with significant difference（P 〈0.05）. The ratios of readjustment of ventilation were 43.9% and 20. 5% ,respectively（P 〈0. 05）. The ultimate proper tidal volume was（8.2 ＋ 0. 8） ml/kg on ideal bodyweight. Conclusion：Setting initial tidal volume according to ideal bodyweight can significantly decrease the ratio of readjustment of ventilation. If the setting of respiratory rate is 16 beats/minute,8 ml/kg ideal bodyweight would be an appropriate initial setting of tidal volume for patients with normal lung function.
出处
《中国循环杂志》
CSCD
北大核心
2005年第5期378-380,共3页
Chinese Circulation Journal
关键词
机械通气
理想体重
心脏手术
Mechanical ventilation
Ideal bodyweight
Cardiac procedure
