镇静对机械通气患者呼吸力学及氧代谢的影响  

Effects of sedation on respiratory mechanic dynamics and oxygen metabolism in patients with mechanical ventlilation

作　　者：方雪玲[1] 何国军[1] 方强[1] 

机构地区：[1]浙江大学医学院附属第一医院监护室,杭州310003

出　　处：《中华急诊医学杂志》2007年第11期1180-1183,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨镇静对机械通气病人呼吸力学、肺内分流率、氧代谢的影响。方法60例机械通气患者随机分为对照组和镇静组,镇静组给予丙泊酚,维持患者镇静水平于RamsayⅢ～Ⅳ级;对照组给予同等剂量的生理盐水,用药前及2 h后抽取肺动脉混合静脉血和动脉血行血液气体分析,同时记录心率、血压、呼吸频率、气道阻力。两组间比较采用t检验。结果用药后两组患者的氧合指数、血压、血乳酸、肺静态总顺应性和肺内分流率差异无统计学意义;心率、呼吸频率、氧摄取率和气道阻力镇静组低于对照组(P<0.05);混合静脉血氧分压镇静组高于对照组(P<0.05)。结论镇静可以降低机械通气患者的氧摄取率和气道阻力;对氧合指数、肺静态总顺应性和肺内分流率无影响。Objective To investigate the effect of sedation on respiratory mechanic dynamics, intrapulmonary shunt fraction, oxygen metabolism in patients with mechanical ventilation. Method Sixty patients with mechanical ventilation were divided randomly into control group and sedation group. Propofal was administered to patients, whose ramsay scores were kept at Ⅲ or Ⅳ levels, in sedation group while the equal amount of normal saline was given in control group. Mixed venous blood and arterial blood samples were taken for blood gas analysis in both groups before and at 2 hours after administration. Heart rate, blood pressure, breathing rate and airway resistance all were recorded at the same time. Results There were no significant differences in oxygenation index, blood pressure, blood lactic acid, total lung static compliance and intrapulmonary shunt fraction between two groups before and after administration. Heart rate, respiratory rate, oxygen uptake and airway resistance of patients in sedation group were lower than those in control group, and partial pressure of oxygen in mixed venous blood of patients in sedation group were higher than those in control group. These differences were statistically significant. Conclusions Sedation can decrease oxygen uptake and airway resistance of patients with mechanical ventilation. However, no alteration in the oxygenation index, total lung static compliance and intrapulmonic shunt ratio can be observed.

关 键 词：镇静 机械通气 氧代谢 呼吸力学 肺内分流率 

分 类 号：R459.7[医药卫生—急诊医学]