摘要
目的 观察脓毒性休克患者在进行机械通气时,不同频率控制通气对血流动力学、呼吸力学、氧代谢各项指标的影响.方法 筛选ICU收治的脓毒性休克患者中符合入选标准的患者共20例纳入研究.在持续药物镇静状态下给予基础通气条件：双水平正压通气（BiPAP ）模式,吸气压力（positive end-expiratory pressure high,PEEPh）=25cmH2O,呼气末正压（positive end-expiratory pressure high,PEEP）=5cmH2O,控制通气频率（frequency,F）=20次/min,压力支持（pressure support,PS）=0cmH2O,氧浓度（FiO2）根据氧合情况调整,脉氧饱和度维持在95%～100%.调整PEEPh,从25cmH2O 开始,以2cmH2O递增或递减,至转变为完全控制通气时为止,此时的PEEPh为所需设定值.将每位患者的F按随机顺序设置为20次/min（F20组）、15次/min（F15组）、10次/min（F10组）、5次/min（F5组）.通气20min后测定并记录血流动力学、氧代谢和呼吸力学指标.结果 ①不同频率控制通气对血流动力学的影响：随着控制通气频率的减少,自主呼吸比例增加,心排指数（cardiac output index,CI）、胸腔内血容积指数（intrathoratic blood volume index,ITBVI）、平均动脉压（mean arterial pressure,MAP）增加,体循环阻力指数（systemic vascular resistance index,SVRI）、中心静脉压（central venous pressure,CVP）降低,具有显著的相关性（P＜0.01）.控制通气频率与心率（heart rate,HR）、血管外肺水（extravascular lung water index,EVLWI ）之间均无相关性（P＞0.05）.组间比较：F5组与F20组相比,CI、ITBVI、MAP增加,SVRI、CVP降低,有统计学差异（P＜0.05）;F10组与F20组相比,CI、ITBVI增加,CVP降低,有统计学差异（P＜0.05）;F15组与F20组相比,仅CVP降低,有统计学差异（P＜0.05）.EVLWI 、HR各组间两两比较均无统计学差异（P ＞0.05）.②不同频率控制通气对呼吸力学的影响：随着控制通气频率的减少,气道峰压（peak air-way pressure,Ppeak）和平均气道压（mean air-way pressure,Pmean）降低,具有相关性（P＜0.05）.F5组与F20组相比Ppeak和Pmean均降低,具有统计学差异（P＜0.05）;其余各组之间比较无统计学差异（P＞0.05）.③不同频率控制通气对氧代谢的影响：随着控制通气频率的减少,氧输送（oxygen delivery,DO2）增加（P＜0.01）,氧合指数下降（P＜0.05）,均具有相关性.氧合指数组间两两比较均无统计学差异（P均＞0.05）.F5组DO2值最大,与其他各组相比均具有统计学差异（P＜0.05）;F10组与F20、F15组相比也具有统计学差异（P＜0.05）.结论 对于机械通气的脓毒性休克患者,随着控制通气比例的降低,自主呼吸比率增加,使心脏前负荷和心输出量增加,提高了氧输送,可能与气道压降低有关.
Objective To observe the effect of different frequency of control ventilation on the indicators of hemodynamics,respiratory mechanics,oxygen metabolism in the patients of septic shock during mechanical ventilation. Methods Screening the septic shock patients with mechanical ventilation in EICU of our hospital. Ultimately 20 cases were included in the study.Sedative drugs continued to be given in whole test process. BiPAP ventilation was given as elementary mode：inspiratory pressure（PEEPh） was 25cmH20;PEEP values was 5cmH2O;frequency was 20bpm;PS was 0;SPO2 was retained at 95% - 100% by adjusting the oxygen concentration.And the adjusted PEEPh from 25cmH2O,increasing or reducing 2cmH2O every time,until spontaneously breathing disappearing.Now the PEEPh was the value.At last randomly adjusted frequency ventilation five,ten,fifteen,twenty to every patient.And then recorded the hemodynamics,mechanical respiration,oxygen metabolism after twenty min.Results ①The effects of different frequency control ventilation on hemodynamic：with controlled ventilation frequency decreased,the proportion of breathe independently increased,and then CI,ITBVI,MAP increased,and SVRI,CVP decreased（P 〈 0.01）.The indicator changes and the adjustment of the frequency control ventilation has obvious relevance（all P 〈 0.01）.HR and EVLWI has no significant change（P 〉 0.05）.In four groups F5 group CI,ITBVI,MAP value is the largest,and SVRI,CVP value is the smallest.Compared with the F20 group,has the significant difference（P 〈 0.05）.Compared with 15,with the exception of MAP, CVP, also has significant difference（P 〈 0.05）.②The effects of different frequency control ventilation on respiratory mechanics：with controlled ventilation frequency decreased,the proportion of breathe independently increased,Pmean and Ppeak lower（P 〈 0.05）,which has a significant correlation（P 〈 0.05）.F5 group compared with the F20 group,Ppeak and Pmean are lower,with significant difference（P 〈 0.05）;other groups showed no significant difference between each other（P 〉 0.05）.③The effects of different frequency control ventilation on oxygen metabolism：with controlled ventilation frequency decreased,oxygen delivery（DO2） increased（P 〈 0.01）,oxygenation index decreased（P 〈 0.05）.Compared with each other oxygenation index group has no statistical difference（P 〉 0.05）.In F5 group DO2 value is the most,and compared with the other groups has a significant difference（P 〈 0.05）;There is also differences between F10 group and the F20,FI5 group（P 〈 0.05）. Conclusions For septic shock patients with mechanical ventilation,with the proportion of control ventilation is decreased,spontaneous breathing ratio will be increased,the cardiac preload,cardiac output and oxygen delivery will be increased,which may result from the reduction of the airway pressure.
出处
《中国血液流变学杂志》
CAS
2011年第3期439-442,482,共5页
Chinese Journal of Hemorheology
关键词
脓毒性休克
机械通气
血流动力学
呼吸力学
氧代谢
septic shock
ventilation
hemodynamics
respiratory mechanics
oxygen metabolism
