定容和定压通气在急性肺损伤中的应用研究  

Application of pressure and volume limited ventilation in acute lung injury

作　　者：叶振海[1] 

机构地区：[1]宁夏医学院附属医院ICU,银川750004

出　　处：《中国医师进修杂志（内科版）》2006年第12期42-44,46,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的通过比较在急性肺损伤中应用定容通气(VLV)和定压通气(PLV)对患者呼吸力学、血气分析及血流动力学的影响,探讨其在急性肺损伤时实施肺保护策略中的临床意义。方法42例急性肺损伤患者随机分为VLV组和PLV组,进行机械通气治疗,观察并比较两组患者呼吸力学、血气分析及血流动力学指标的变化。结果通气24h两组气道峰压(PIP)较通气开始时升高,且PLV组升高小于VLV组;而两组平均气道压(MPAW)较通气开始时降低,且VLV组降低大于PLV组;通气24h两组吸呼比(I∶E)及呼吸频率较通气开始时降低,但两组间比较差异无统计学意义;两组患者机械通气24h后中心静脉压(CVP)升高,VLV组上升更明显;两组机械通气治疗后心率明显减慢,PLV组减慢更显著;两组同时间点平均动脉压(MAP)比较差异无统计学意义;两组动脉血氧分压在通气24h后明显升高,PLV组升高更明显,动脉血二氧化碳分压较治疗前降低,两组间比较差异无统计学意义。两组气压伤发生率均较低。结论VLV和PLV应用于急性肺损伤肺通气策略时可有效改善患者的氧合,促进二氧化碳排出,减少气压伤的发生,对血流动力学影响小,PLV更能改善患者的呼吸力学,更适合急性肺损伤患者的保护性通气。Objective To investigate the significance and effect of pressure limited ventilation （PLV） as well as volume limited ventilation （VLV） by lung protective strategy on respiratory mechanics, blood gas analysis and hemodynamics in patients with acute lung injury （ALl）. Methods Forty-two patients with ALl were randomly divided into PLV group and VLV group, all were given treatment of mechanical ventilation. Changes in respiratory mechanical, blood gas analysis and hemodynamies were compared between the two groups. Resnlts After 2：4 hours mechanical ventilation, mean pressure of airway （ MPAW）, inhale： expire （ I： E）, respiratory rate （ RR）, heart rate （HR） and partial pressure of carbon dioxide in artery（ PaCO2 ）in two groups were lower than before mechanical ventilation. While peak inspiratory pressure （PIP）, central venous pressure （CVP）, partial pressure of oxygen in artery（ PaO2 ）and pH were higher than those before. With mechanical ventilation treated, PIP, CVP and HR in VLV group were higher than those in PLV group. And while MPAW and PaO2 in VLV group were lower than those in PLV group. The two groups had no differences in I： E, R, MAP, PaO2 and pH at various interval. The two groups had little ventilator - induced lung injury. Conclusion The ventilation mode of VLV and PLV can improve arterial blood oxygenations, promote the carbon dioxide setout, have less disturbance in hemndynamie parameters, and prevent ventilator - induced lung injury. The PLV mode is better to improve the respiratory mechanics, and is more fit on lung protective ventilatory in ALl.

关 键 词：定容通气 定压通气 急性肺损伤 肺保护性通气 

分 类 号：R563[医药卫生—呼吸系统]