不同机械通气方式对大面积烧伤患者每搏量变异度的影响

发布时间：2018-03-23 00:30

本文选题：机械通气方式　切入点：烧伤　出处：《广东医学》2015年18期 　论文类型：期刊论文

【摘要】：目的探讨不同机械通气方式对大面积削痂植皮手术患者每搏量变异度(SVV)的影响。方法选择烧伤中心ICU行大面积削痂植皮手术的患者54例,ASAⅠ~Ⅱ级。患者术前30 min肌肉注射苯巴比妥钠0.1g、阿托品0.5 mg。入室后面罩吸氧,接多功能监护仪连续监测血压、心率、心电图、脉搏血氧饱和度。局部麻醉下行桡动脉穿刺置管,连接Flo Trac压力换能器、Vigileo持续心排量监护仪和多功能监护仪,持续监测平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、每搏量(SV)、每搏量指数(SVI)及SVV。麻醉诱导后经颈内静脉或锁骨下静脉置入中心静脉双腔导管,持续监测中心静脉压(CVP)。机械通气10 min后54例患者分为3组:容量通气模式(VC)组、压力通气模式(PC)组和压力调节容量控制模式(PCV)组。记录麻醉诱导前(T0)、机械通气后10min(T1)、30 min(T2)、60 min(T3)、手术结束(T4)时的MAP、心率(HR)、CO、CI、SV及SVI;记录机械通气后T1、T2、T3及T4时的SVV、CVP、平均气道压(Pm)、峰压(Pi)、平台压(PL)及吸气最大流速(MF)。结果 3组患者各时点的MAP、HR、CI、CVP、Pm、Pi值比较差异无统计学意义(P0.05);VC组、PCV组的SV值在各时点呈增加趋势,而PC组的SV呈下降趋势,VC组、PC组在T3时点的SV值比较差异有统计学意义(P0.05);PC组在T2、T3、T4时的SVV、MF明显升高,与VC组、PCV组比较差异有统计学意义(P0.05),PCV组在各时点SVV值虽高于VC组(P0.05),VC组、PCV组在T2、T3、T4时点MF差异有统计学意义(P0.05)。结论 SVV能较准确地预测容量控制通气模式下的烧伤手术患者对液体治疗的反应性,而在应用压力控制通气或容量保证压力调节通气模式时,SVV的准确性受到明显影响。因此,在以SVV来评估心脏前负荷及指导烧伤患者的液体治疗时,应充分考虑通气模式这一影响因素。
[Abstract]:Objective to investigate the effect of different mechanical ventilation modes on SVV in patients undergoing large area escharectomy and skin grafting. Methods 54 patients with large area escharectomy and skin grafting were selected from burn center ICU. 30 patients were treated before operation. Min was injected intramuscularly with phenobarbital (0.1 g) and atropine (0.5 mg). Continuous monitoring of blood pressure, heart rate, electrocardiogram, pulse oxygen saturation was carried out by multifunctional monitor. Radial artery puncture catheter was inserted under local anesthesia, and Flo Trac pressure transducer was connected with Vigileo continuous cardiac output monitor and multifunction monitor. Continuous monitoring of mean arterial pressure MAPP, cardiac output, cardiac index, SVI, SVV.Intrajugular vein or subclavian vein were inserted into the central vena cava after anesthesia induction. 54 patients after 10 min of mechanical ventilation were divided into 3 groups: VCgroup with VCV mode. Before anesthesia induction, 10 min after mechanical ventilation, 30 min after mechanical ventilation, 60 min after operation and 60 min after operation, mitogen, heart rate, HRT, COCISV and SVI were recorded, and SVVCVP at T 1 T 2T 3 and T 4 after mechanical ventilation were recorded. Results there was no significant difference in Pi value between the three groups at different time points. The SV value of PCV group showed an increasing trend at each time point. The SV of PC group showed a decreasing trend. The SV value of PC group was significantly higher than that of VC group at T3 time. The SVVMF of PC group was significantly higher than that of PC group at T _ 2T _ 3 ~ T _ 4, P _ (0.05) and T _ (2) T _ (3) T _ (4). Compared with VC group, there was a significant difference in SVV value between P0.05 group and VC group at each time point. Conclusion SVV can accurately predict burn hand under volume-controlled ventilation mode, although it is higher than that in VC group P0.05 and VC group at T _ 2T _ 3N _ 4 time point. The reactivity of surgical patients to liquid therapy, The accuracy of VV was significantly affected by the use of pressure-controlled ventilation or volume-guaranteed pressure-regulated ventilation. Therefore, in evaluating cardiac preload and guiding fluid therapy in burn patients with SVV, The influencing factors of ventilation mode should be fully considered.
【作者单位】：暨南大学医学院第四附属医院;广东省广州市红十字会医院麻醉科;广东省广州市天河区妇幼保健院麻醉科;
【基金】：广州市中医药和中西医结合科研项目(编号:20122A011014)
【分类号】：R644

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