摘要
目的在心肺复苏期间进行机械通气,当选择容量控制(VCV)模式下使用减速波时,通过分析峰流量分别选择50 L/min(正常)和30 L/min(小流量)时对气道高压程度的影响,探讨何种峰流量更适合心肺复苏期间机械通气的要求。方法纳入2012年1月至2014年1月期间在急诊科进行心肺复苏的患者30例。在同一操作者按压下心肺复苏进入平稳状态后,患者呼吸机其他参数不变,在峰流量分别为50 L/min和30 L/min时,随机冻结各自一个呼吸周期的压力-时间曲线图,测量吸气相气道峰压中的最高值。结果使用峰流量分别为50 L/min、30 L/min时平均气道峰压高值分别为(54.1±4.9)cm H2O和(35.5±5.3)cm H2O,患者气道峰压高值大于40 cm H2O的发生率分别为96.7%和26.7%,气道峰压高值大于50 cm H2O的发生率分别为76.7%和0%。相对于50 L/min,30 L/min的峰流量可明显降低患者的气道峰压(P=0.000)。结论心肺复苏机械通气在VCV模式下使用减速波时,选择低于正常水平的较小的峰流量(如30 L/min)较正常流量(如50 L/min)可明显降低气道峰压,明显减轻由于胸外按压持续存在导致气道内压力的反复剧烈变化而对呼吸机的影响,且使大多数患者气道峰压低于40 cm H2O,是比较合理且安全的选择。
Objective To investigate the effects of different peak flow on the airway pressure to explore a preferable value of peak flow in ventilation during cardiopulmonary resuscitation （CPR） under volume control ventilation （VCV） mode and decreasing-wave. Methods 30 patients who underwent CRP in the emergency unit between January 2012 and 2014 was recruited in the study. When the chest compressions came into a stable state by a same doctor,the peak flow was set at 50 L/min and 30 L/min respectively while other parameters fixed in the same patient. Then the pressure-time curve of a respiratory cycle was randomly frozen to achieve the highest peak pressure in inspiratory phase. Results The highest peak airway pressures were （54. 1±4.9）cm H20 and （35.5±5.3）cm H20 when the peak flow were set at 50 L/min and 30 L/min respectively with significant difference. The incidence of peak airway pressure greater than 40 cm H20 was 96. 7% and 26. 7%, and the incidence of peak airway pressure greater than 50 em H2O was 76. 7% and 0% , respectively. Compared with 50 L/rain, the peak flow of 30 L/min obviously reduced the peak pressure （P = 0. 000）. Conclusions In the mechanical ventilation during CPR using VCV mode and decreasing-wave, compared with peak flow of 50 L/min, smaller peak flow of 30 L/min can significantly reduce peak airway pressure, and significantly reduce the adveme effects to ventilation by repeated violent changes in airway pressure caused by continuing chest compressions, and make airway peak pressure under 40 cm H2O in most patients,so it is a reasonable and safe choice.
出处
《中国呼吸与危重监护杂志》
CAS
2014年第4期357-359,共3页
Chinese Journal of Respiratory and Critical Care Medicine
基金
浙江省丽水市科技局2010年度医学重点建设学科科技项目
关键词
心肺复苏
机械通气
峰流量
减速波
气道峰压
Cardiopulmonary resuscitation
Mechanical ventilation
Peak flow
Deceleratingwave
Peak airway pressure
