摘要
目的观察腹腔压力（IAP）变化对腹内高压（IAH）患者机械通气效果的影响,比较常规通气方式和小潮气量（VT）通气方式对腹腔间室综合征（ACS）患者机械通气效果。方法采用前瞻性研究方式对24例IAH的机械通气患者,分别在腹内高压时与腹压缓解后两个阶段对其呼吸力学及动脉血气指标进行监测。将其中符合ACS诊断的8例患者以自身对照方式,将两种通气模式按交叉对照设计方式分别在每个患者身上实施2~4次：A组为常规通气模式,VT为10 mL/kg,PEEP≤3 cm H2O;B组为小潮气量通气模式,VT为6 mL/kg,PEEP≥8 cm H2O;每种模式通气持续2 h后收集相关数据并转换模式,最后将两组通气模式下收集的数据进行比较。结果腹胀缓解后,患者的通气和换气功能均明显改善;顺应性（C）明显提高（P〈0.01）,气道峰压（PIP）有所下降（P〈0.05）,但气道阻力（R）无明显变化（P〉0.05）。小潮气量通气方式下,IAH患者的换气功能明显改善,但并不能改善通气,PIP降低（P〈0.01）,平均气道压（Pmean）升高（P〈0.01）,但C和R无明显变化（P〉0.05）。结论降低腹压能明显改善IAH患者的通气和换气功能;对于IAH的机械通气患者,可考虑采用小潮气量通气方式,较常规通气方式更有利于改善肺部气体交换。
Objective：tive To observe the effects of mechanical ventilation on the patients with intra-abdominal hypertension（IAH） when changing of intra-abdominal pressure（IAP） ;To compare the effects of mechanical ventilation between conventional mechanical ventilation and low tidal volume（VT） ventilation on the patients with abdominal compartment syndrome（ACS）. Methods A pro- spective study was performed in 24 ventilated patients with IAH,the data of respiratory mechanics and artery blood gas analysis at the stage of maximum intra-abdominal pressure and mild intra-abdominal pressure were collected. In 8 patients according with ACS diagnosis were enrolled, two kinds of ventilation were repeated 2--4 times in each patient according to randomized cross-over design and self-control approach： group A（conventional ventilation, VT as 10 mL/kg, PEEPS3 cm H2 O） ; group B（low tidal volume venti- lation, VT as 6 mL/kg, PEEP≥8cm H2 O）. After 2 hours of ventilation, the data of respiratory mechanics and artery blood gas anal- ysis were collected and the ventilation mode was exchanged to another. Finally the data from two sets of ventilation mode were com- pared. Results In 24 patients with IAH,the ventilation and gas exchange function improved significantly as intra abdominal pres- sure decreased, respiratory system compliance increased obviously（P〈0.01 ） and peak inspiratory pressure （PIP） decreased （P 〈0.05） ,but there was no difference in airway resistance between the two stages（P〉0.05）. Compared with the group A,gas ex- change function but not ventilation was improved, the PIP decreased（P〈0.01）and Pmean increased obviously（P〈0.01）in group B. There was no difference in respiratory system compliance and airway resistance between the two groups（P〉0.05）. Conclusion The function of ventilation and gas exchange in patients with IAH may improved significantly as intra-abdominal pressure de- creased. For the patients with IAH,it maybe rather to using small tidal volume
出处
《重庆医学》
CAS
CSCD
北大核心
2010年第13期1657-1659,共3页
Chongqing medicine
关键词
腹内高压
腹腔间室综合征
机械通气
intra-abdominal hypertension
abdominal compartment syndrome
mechanical ventilation
