摘要
目的探讨不同机械通气潮气量对肺损伤的影响。方法选取哈尔滨医科大学附属第一医院自2015年6月至2017年6月收治的66例急性肺损伤患者为研究对象。按照压力-容积曲线下拐点+0. 196 k Pa确定呼气末正压,根据压力-容积曲线的上拐点对应出潮气量,其中,给予100%潮气量者为A组(n=22)、给予85%潮气量者为B组(n=22)、给予70%潮气量者为C组(n=22)。比较各组患者经不同机械通气潮气量后,血流动力学指标、肺通气及换气、肺力学特征指标的变化。结果各组患者治疗后平均动脉压比较,差异无统计学意义(P> 0. 05)。B组、C组患者治疗后心率、中心静脉压均明显低于A组,组间比较,差异有统计学意义(P <0. 05); B组与C组治疗后心率、中心静脉压比较,差异无统计学意义(P>0. 05)。各组患者治疗后动脉血气pH值比较,差异无统计学意义(P> 0. 05)。A组、C组患者治疗后氧分压、氧合指数均明显低于B组,组间比较,差异有统计学意义(P <0. 05)。A组、B组治疗后二氧化碳分压明显低于C组,且A组低于B组,组间比较,差异均有统计学意义(P <0. 05)。B组、C组的气道峰值压、平均气道压明显低于A组,差异有统计学意义(P <0. 05):B组与C组气道峰值压、平均气道压比较,差异无统计学意义(P> 0. 05)。A组、C组肺静态顺应性明显低于B组,且A组低于C组,组间比较,差异均有统计学意义(P <0. 05)。结论以压力-容积曲线的下拐点来确定呼气末正压值,以上拐点压力对应的潮气量的85%对潮气量进行调节与设定,能更好的促进改善肺顺应性。
Objective To investigate the effects of different mechanical ventilation tidal volume on lung injury.Methods A retrospective study was performed on 66 cases of patients with acute lung injury who were admitted from July 2015 to July 2017.According to the inflection point ＋0.196 kPa under the pressure-volume curve,the positive pressure at the end of breath was determined.According to the inflection point above the pressure-volume curve,the tidal volume was corresponded to the tidal volume Among them,patients in Group A（ n =22）were given 100% of the tidal volume,patients in Group B（ n =22）were given 85% of the tidal volume,and patients in Group C（ n =22）were given 70% of the tidal volume.The changes of hemodynamic parameters,pulmonary ventilation and ventilation,and pulmonary mechanical characteristics were compared in each group.Results There was no statistically significant difference in MAP between the three groups（ P 〉0.05）.The HR and CVP of Group B and Group C were significantly higher than those in Group A,and the difference was statistically significant（ P 〈0.05）.There was no statistically significant difference in HR and CVP between Group B and Group C（ P 〉0.05）.There was no statistically significant difference in pHa in the three groups（ P 〉0.05）.PaO 2 and PaO 2/FiO 2 after treatment in Group A and Group C were significantly lower than those in Group B（ P 〈0.05）.PaCO 2 in Group A and Group B were significantly lower than that in Group C（ P 〈0.05）.The PIP and Pm levels in Group B and Group C were significantly lower than those in Group A（ P 〈0.05）;there was no statistically significant difference in PIP and Pm levels between Group B and Group C（ P 〉0.05）.The Cst level of Group A and Group C was significantly lower than that of Group B,and the Cst level of Group A was significantly lower than that of Group C（ P 〈0.05）.Conclusion The positive end-expiratory pressure value is determined by the inflection point of the pressure-volume curve.T
作者
白杨
刘尚典
BAI Yang;LIU Shang-dian(Emergency Intensive Care Unit,First Affiliated Hospital of Harbin Medical University Qunli Hospital Area,Harbin 150077,China)
出处
《创伤与急危重病医学》
2018年第6期375-377,共3页
Trauma and Critical Care Medicine
基金
黑龙江省青年科学基金项目(QC2017101)
关键词
机械通气
潮气量
压力-容积曲线
肺损伤
Mechanical ventilation
Tidal volume
Pressure-volume curve
Lung injury
