摘要
目的 通过分析心肺复苏患者在高级生命支持阶段的机械通气时气道峰压水平,为选择合理的气道高压报警上限提供依据.方法 选择进行心肺复苏时间>20min的患者,使用伟康Eisprit呼吸机,合理设定呼吸机其他工作参数,初始设置气道高压报警值为40cmH2O,如果患者气道峰压>40cmH2O则上调至50cmH2O,如果>50cmH2O则上调至60cmH2O为止不再上调,用呼吸机自带的测量软件测量患者的气道峰压高值,并记录气胸等不良反应的发生情况,共完成60例患者的数据收集和分析.结果 气道峰压>40cmH2O的患者占76.7%,<50cmH2O患者占81.6%,56~60cmH2O患者占5%,6.7%患者>60cmH2O.有2例气道峰压>55cmH2O的患者在12h内出现少量气胸.结论 心肺复苏高级生命支持期间的机械通气,因患者气道峰压普遍高于常规设置气道高压报警而容易发生人机不协调,据本次资料,调整呼吸机参数将患者气道峰压控制在<55cmH2O,以避免气压伤的发生是有必要的.而将气道高压报警设置为50cmH2O,既能保证患者的气道安全,又不会引起过多不必要的报警事件,也是比较合适的初始设置.
Objective To analyze the patient's peak airway pressure level of mechanical ventilation during the advanced life support stage in cardiopulmonary resuscitation,to provide a basis for a reasonable airway high pressure alarm range.Methods The patients whose CPR time was more than 20minutes in hospital were chosen.The Eisprit respirator was used and other parameters were set reasonably.The alarm value of airway high pressure to 40 cmH2O was set initially.If the peak airway pressure is more than 40cmH2O,the alarm value will be raised to 50cmH2O.If the peak airway pressure is more than 50cmH2O,the alarm value will be raised to 60cmH2O,and no longer up-regulated.The peak airway pressure was measured with the measurement software of the ventilator,and the occurrence of adverse reactions such as pneumothorax was recorded.The data of 60 patients were collected and analyzed.Results 6.7%of patients with peak airway pressure above 40cmH2O,81.6%of patients below 50cmH2O,5%of patients with peak airway pressure between 56-60cmH2O and 6.7%of patients above 60cmH2O.Two patients with peak airway pressure higher than 55cmH2O had a small amount of pneumothorax within 12 hours.Conclusion Mechanical ventilation during advanced life support of cardiopulmonary resuscitation is prone to man-machine incoordination because the patients'airway peak pressure is generally higher than the routine setting of high pressure airway alarm.According to this data,it is necessary to adjust the parameters of ventilator to control the patients'airway peak pressure below 55cmH2O to avoid the occurrence of barometric injury.Setting the high-pressure airway alarm as 50cmH2O can not only ensure the airway safety of patients,but also avoid excessive unnecessary alarm events,which is also a more appropriate initial setting.
出处
《浙江临床医学》
2019年第12期1654-1655,共2页
Zhejiang Clinical Medical Journal
基金
浙江省医药卫生科技计划项目(2018KY940)
浙江省丽水市科技局高层次人才项目(2O15RC11)。
关键词
心肺复苏
高级生命支持
机械通气
气道高压报警
Cardiopulmonary Resuscitation
Advanced life support
Mechanical ventilation
Peak airway pressu
