压力调整容量控制通气在腹腔间隔室综合征中的应用研究

发布时间：2018-12-21 19:35

【摘要】：目的探讨常规容量控制(VC)通气和压力调整容量控制(PRVC)通气对腹腔间隔室综合征(ACS)患者通气效果的影响。方法选取2011年5月—2014年5月江苏大学附属医院ICU收治的ACS患者36例,均行机械通气治疗,采用随机数字表法分为两组:A组19例采用同步间歇指令-容量控制(SIMV-VC)模式,B组17例采用同步间歇指令-压力调整容量控制(SIMV-PRVC)模式,采集两组患者第1天、第3天及第5天血气分析指标、呼吸力学指标、血流动力学指标及序贯器官衰竭估计评分(SOFA评分)。结果 A组与B组患者不同时间动脉血氧分压(Pa O2)、氧合指数(Pa O2/Fi O2)、吸气峰压(PIP)、肺静态顺应性(Cst)比较,存在交互作用(P0.05);A组与B组患者不同时间动脉血二氧化碳分压(Pa CO2)、肺泡-动脉氧分压差(A-a DO2)、气道平均压(Pmean)、气道阻力(R)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、SOFA评分比较,不存在交互作用(P0.05);组间Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、Pmean、Cst、R、CVP、SOFA评分比较,差异有统计学意义(P0.05);组间PIP、HR、MAP比较,差异无统计学意义(P0.05);不同时间间Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、PIP、Pmean、Cst、R、MAP、CVP、SOFA评分比较,差异有统计学意义(P0.05);不同时间间HR比较,差异无统计学意义(P0.05)。结论 SIMV-PRVC模式机械通气治疗ACS患者,可明显改善Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、Pmean、Cst、R、CVP、SOFA评分,符合肺保护性通气策略的要求。
[Abstract]:Objective to investigate the effect of routine volume controlled (VC) ventilation and pressure adjusted volume controlled (PRVC) ventilation on the ventilation effect in patients with abdominal compartment syndrome (ACS). Methods from May 2011 to May 2014, 36 patients with ACS were treated with mechanical ventilation in ICU, affiliated Hospital of Jiangsu University. The method of random digital table was used to divide the patients into two groups: group A (19 cases) received synchronous intermittent instruction-volume control (SIMV-VC) mode, group B (17 cases) adopted synchronous intermittent instruction-pressure adjusted volume control (SIMV-PRVC) mode, two groups of patients were collected on the first day. On the 3rd and 5th day, the indexes of blood gas analysis, respiratory mechanics, hemodynamics and SOFA score were evaluated. Results the arterial oxygen partial pressure (Pa O 2), oxygenation index (Pa O2/Fi O 2), inspiratory peak pressure (PIP),) and pulmonary static compliance (Cst) in group A and group B were compared at different times (P0.05). Arterial blood carbon dioxide partial pressure (Pa CO2), alveolar to arterial partial pressure of oxygen (A-a DO2), mean airway pressure (Pmean),) (Pmean), airway resistance (R), heart rate (HR), mean arterial pressure (MAP),) in group A and group B at different times There was no interaction in (CVP), SOFA score of central venous pressure (P0.05). There was significant difference in the scores of Pa O 2 Pa CO2,A-a DO2,Pa O2/Fi O 2 P mean PIP,HR,MAP between the two groups (P0.05), but there was no significant difference in PIP,HR,MAP between the two groups (P0.05). There was significant difference in Pa O 2 Pa CO2,A-a DO2,Pa O2/Fi O 2 P PIP mean CSTP map CVPSOFA score between different time groups (P0.05), but there was no significant difference in HR comparison between different time groups (P0.05). Conclusion SIMV-PRVC mechanical ventilation can obviously improve the score of Pa O _ 2 Pa CO2,A-a DO2,Pa O2/Fi O _ 2 P _ (2 +) CO2,A-a DO2,Pa O2/Fi C _ (2) P _ (SOFA), which meets the requirements of lung protective ventilation strategy.
【作者单位】：江苏大学附属医院ICU;
【基金】：镇江市科技支撑计划(社会发展)资助项目(SH2013037)
【分类号】：R459.7

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