摘要
目的 比较急性呼吸窘迫综合征 (ARDS)时实行肺保护通气策略中 ,压力控制通气 (PCV)和容量控制通气 (VCV)模式对患者呼吸力学、血气及血流动力学的影响 ,并探讨其临床意义。方法 5 0例 ARDS患者按随机表法分为 PCV组和 VCV组进行机械通气治疗 ,均实行允许高碳酸血症策略和肺开放策略 ,比较两组患者呼吸力学、血气及血流动力学各指标的变化。结果 PCV组通气 2 4 h气道峰压低于 VCV组 ,而平均气道压高于 VCV组 ;两组通气 2 4 h后中心静脉压明显升高 ,而 VCV组上升更明显 ;两组治疗后心率显著减慢 ,PCV组改善更明显 ;两组同时间点平均动脉压比较均无显著性差异 ;两组均未发生气压伤 ;两组治疗2 4 h后 Pa O2 比治疗前均明显升高 ,PCV组改善更明显。结论 对于 ARDS患者在实行肺保护通气策略时 ,PCV和 VCV通气模式均可改善氧合 ,防止气压伤的发生 ,对患者血流动力学影响小 ,PCV模式控制气道峰压更有效 ;主张对于 ARDS患者尽量采用
Objective To investigate the significance and effect of pressure controlled ventilation (PCV) as well as volume controlled ventilation (VCV) by lung protective strategy on respiratory mechanics, blood gas analysis and hemodynamics in patients with acute respiratory distress syndrome (ARDS). Methods Fifty patients with ARDS were randomly divided into PCV and VCV groups with permissive hypercapnia and open lung strategy. Changes in respiratory mechanics, blood gas analysis and hemodynamics were compared between two groups. Results Peak inspiration pressure (PIP) in PCV group was significantly lower than that in VCV group, while mean pressure of airway(MP aw ) was significantly higher than that in VCV after 24 hours mechanical ventilation. After 24 hours mechanical ventilation, there were higher central venous pressure(CVP) and slower heart rate(HR) in two groups, CVP was significantly higher in VCV compared with PCV, and PCV group had slower HR than VCV group, the two groups had no differences in mean blood pressure(MBP) at various intervals. All patients showed no ventilatorinduced lung injury. Arterial blood oxygenations were obviously improved in two groups after 24 hours mechanical ventilation, PCV group had better partial pressure of oxygen in artery(PaO 2) than VCV group. Conclusion Both PCV and VCV can improve arterial blood oxygenations, prevent ventilatorinduced lung injury, and have less disturbance in hemodynamic parameters. PCV with lung protective ventilatory strategy should be early use for patients with ARDS.
出处
《中国危重病急救医学》
CAS
CSCD
2004年第7期424-427,共4页
Chinese Critical Care Medicine
关键词
压力控制通气
容量控制通气
呼吸窘迫综合征
急性
肺保护策略
pressure control ventilation
volume control ventilation
acute respiratory distress syndrome
lung protective strategy
