摘要
目的 探讨不同机械通气策略对急性肺损伤 (ALI)患者血液、呼吸动力学和氧代谢的影响。 方法 本组共 2 6例ALI患者 ,对其中 14例ALI评分值≥ 2 .5者采用低潮气量 +呼气末正压 (PEEP)通气 ,并依次按 0 ,5 ,10 ,15 ,2 0cmH2 O增加PEEP ;对另外 12例ALI评分值 <2 .5者最初采用辅助 /控制通气 (A/C) ,并逐渐改为间歇辅助通气 (SIMV)和压力支持通气 (PSV)。通过Swan -Ganz导管获得血液动力学和氧代谢参数。 结果 PEEP在 5～ 15cmH2 O范围内 ,动脉血氧分压(PaO2 )、氧合指数 (PaO2 /FiO2 )、氧供给 (DO2 )和肺静态顺应性 (Cst)随着PEEP的增高而逐渐增加 (P<0 .0 5 )。在PEEP增加到 2 0cmH2 O时心输出量 (CO)和Cst下降 ,外周循环阻力 (SVR)、肺循环阻力 (PVR)和气道峰值压 (PIP)增加 (P <0 .0 5 )。SIMV与A/C相比可显著增加DO2 (P <0 .0 5 ) ,PSV与A/C相比可明显降低PIP并使Cst增加 (P <0 .0 5 )。SIMV和PSV方式均可降低SVR。 结论 对ALI不同时期选择不同的机械通气策略 ,可更好的增加氧供 ,减少对呼吸、血液动力学的影响。
Objective To explore the effects of different ventilation tactics on pneumodynamics, hemodynamics and metabolism of oxygen in patients with acute lung injury(ALI). Methods A total of 14 patients with ALI score≥2.5 were ventilated with low tidal and positive end expiratory pressure (PEEP). And the PEEP changed to 0, 5, 10, 15 and 20 cm H 2O, respectively. Twelve patients with ALI score<2.5 were ventilated with A/C, synchronized intermittent mandatory ventilation (SIMV) and pressure support ventilation (PSV). The hemodynamics and the metabolism of oxygen parameters of the two groups were obtained through a Swan-Ganz tube. Results When the levels of PEEP were during 5 to 15 cm H 2O, the partial pressure of oxygen in artery (PaO 2), PaO 2/FiO 2, DO 2 and the compliance static (Cst) increased gradually (P<0.05). The cardiac output (CO) and Cst decreased significantly when the PEEP was 20 cm H 2O, at the same time, the pulmonary vascular resistance (PVR) and the systemic vascular resistance (SVR) increased (P<0.05). Compared with A/C model, DO 2 increased under the SIMV. The peak inflating pressure (PIP) decreased under the PSV but Cst increased. Compared with the A/C model, SVR decreased significantly under the SIMV and PSV models. Conclusions It can better increase DO 2 and decrease the bad effects of pneumodynamics and hemodynamic, when different ventilation tactics are chosen for the patients with ALI.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2001年第5期277-280,共4页
Chinese Journal of Trauma
基金
安徽省教委中标课题基金资助项目!(98JL170 )
