适时序贯组合模式机械通气在危重病人救治中的应用  

Role of real-sequent fixed mechanical ventilation modes in critical patients

作　　者：姜兴权[1] 王育珊[1] 王广[1] 

机构地区：[1]吉林大学第二医院急救医学科,吉林长春130041

出　　处：《中国急救医学》2005年第10期703-706,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨在危重病人救治过程中应用适时序贯组合模式机械通气的临床意义。方法通过对235例次危重病人采用机械通气救治的临床资料进行回顾性分析,并将120例次序贯组合模式组与115例次单一通气模式组进行比较,建立在此类病人进行机械通气时具有肺保护作用的模式组合、参数设置及其适时序贯调节的方法。结果两组危重病人的APACHEⅡ评分和平均年龄比较,差异无统计学意义(P>0.05)。序贯组合模式组64.2%和单一通气模式组52.2%均达到通气目标,组间比较,差异有显著意义(P<0.01)。前组35.8%和后组47.8%因多脏器功能衰竭(MOF)而死亡(APACHEⅡ评分均>29分),组间比较,差异有显著意义(P<0.01)。序贯组合模式组Vt 7.15±1.12 mL/kg、PSV 8.5±2.1 cmH2O、PEEP/CPAP5.16±1.05 cmH2OP、plat 18.5±2.5 cmH2OP、IP 23.5±3.6 cmH2O均低于单一通气模式组(P<0.01)。前组f 20±2.5次/min高于后组(P<0.05)。结论在各种类型危重病人的救治中,应用A/CV+PEEP、SIMV+PSV+PEEP、CPAP+PSV和PSV的适时序贯组合模式通气,采用动态的线性撤机过程,能提高通气达标率和降低病死率,并具有肺保护作用。参数的设置和调节宜在动脉血气指标的量化控制下,应用小Vt、小PSV、小PEEP/CPAP和适当f。Objective The purpose is to explore the role of real - sequent fixed mechanical ventilation modes in critical patients . Methods We retrospectively studied the clinical data of 235 critical cases with mechanical ventilation, and compared 120 critical cases with real - sequent fixed mechanical ventilation mode with 115 cases with traditional single ventilation mode. The pattern fabrication, the layout of parameters and the real - sequent regulation method which had lung protection during mechanical ventilation were established. Results There was no difference in APACHEⅡ grade and mean age between groups （P〉0.05）. Study group （64.2%）and control group （52.2%） reach the ventilation goal respectively and there was significant difference between groups（P〈0.01） . Moreover, the former 35.8% and the latter 47.8% died of MOF（APACHEⅡ grade 〉29）, which meant significant difference between groups（P〈0.01）. The layout of parameter and the scope in study group were Vt 7.15 ± 1.12 mL/kg, PSV 8.5 ± 2.1 cmH2O, PEEP/CPAP 5.16 ± 1.05 cmH2O, Pplat 18.5 ± 2. 5 cmH2O and PIP 23.5 ± 3.6 cmH2O,whieh were all significantly lower than those in control group（P〈0.01） ,however , f 20 ± 2.5 bpm in study group was significantly higher than that in control group（ P〈0.05 ）. Conclusions In the treatment of critical cases, we should adopt the real-sequent fixed mechanical ventilation modes which could increase goal rate and decrease morbidity and mortality and have lung protective role .The layout or regulation of parameters should be determined according to the marker of arterial bloed gas analysis and we should use the pattern of low-Vt, low-PSV , low-PEEP/CPAP and appropriate frequency.

关 键 词：危重症 呼吸衰竭 肺保护 机械通气 

分 类 号：R459.7[医药卫生—急诊医学]