气道压力释放通气和间歇正压通气对急性呼吸衰竭患者心肺功能影响的比较  

Influence on cardiac - pulmonary function of acute respiratory failure patients by airway pressure release ventilation and intermittent positive pressure ventilation modes

作　　者：方智野[1] 钮善福[2] 朱蕾[2] 王健[1] 张敏[1] 

机构地区：[1]广东省深圳市第二人民医院呼吸内科,深圳518035 [2]复旦大学中山医院呼吸内科

出　　处：《中国实用医刊》2008年第12期4-6,共3页Chinese Journal of Practical Medicine

摘　　要：目的观察气道压力释放通气（APRV）模式在临床的应用疗效及其对急性呼吸衰竭（呼衰）患者呼吸、循环功能的影响，并与间歇正压通气（IPPV）进行比较。方法对10例急性呼衰患者先用IPPV模式通气，分别设置呼气末正压（PEEP）为0、5、10cmH2O然后将模式改为APRV，分别设置低压水平PL（即PEEP）=0、5、10cmH2O，相应的高压Ph水平分别为相同PEEP时IPPV平台压。观察通气期间呼吸力学、血气和血流动力学的变化。结果在相同PEEP／PL下，IPPv模式时平均肺动脉压（mPAP）均高于APRV时，但只有在PEEP／PL为5cmH2O时，两者差异有统计学意义。相同PEEP／PL下，IPPV的平均动脉压（mABP）均高于APRV时，但差异无统计学意义，而心输出量（CO）、肺血管阻力（PVR）、体循环阻力（SVR）差异无统计学意义。在相同PEEP／PL下，IPPV时气道峰压（Ppeak）高于APRV时，在PEEP／PL为0和5cmH2O时差异有统计学意义，而两种模式时气道平均压（mPaw）差异无统计学意义。相同PEEP／PL下，AP—RV时的分钟通气量低于IPPV时，差异有统计学意义。而PaO2／FiO2则高于IPPV时，差异有统计学意义。结论在临床急性呼衰患者中，APRV与IPPV相比，能以较小的峰压达到相似的通气效果且氧合功能优于IPPV，对血流动力学的影响两者相似。Objective To observe the influence on cardiac - pulmonary function of acute respiratory failure patients by airway pressure release ventilation （APRV）and intermittent positive pressure ventilation （IPPV） modes. Methods We used IPPV mode in ten acute respiratory failure patients,set PEEP 0, 5 em H20, 10 cm H20 separately, then changed to APRV, set the low pressure PL（PEEP） 0, 5 cm H20, 10 cm H20, set the Ph the same as the plateau pressure （Pplateau）of IPPVat corresponding PEEP level. We observed the changes of respiratory mechanics, blood gas analysis and homodynamic during mechanical ventilation. Results At the same PEEP/PL level, the mean pulmonary artery pressure（mPAP） of IPPV was higher than that of APRV, when PEEP/PL was 5 cm H20, the difference was significant. At the same PEEP/PL level, the mean artery blood pressure（mABP） of IPPV was higher than that of APRV, but the difference was not significant, the cardiac output（CO）, the pulmonary venous resistance （PVR） and systemic venous resistance（SVR） were not different. At the same PEEP/PL level, the peak pressure（Ppeak） of IPPV was higher than that of APRV,when PEEP/PL was 0 and 5 cm H20, the difference was significant, while the mean airway pressure（mPaw） was not different. At the same PEEP/PL level, the minute ventilation （VE） of APRV were lower than that of IPPV, while PaO2/FiO2 were higher than that of IPPV. The difference was significant. Conclusion For acute respiratory failure patients, the oxygenation of APRV is better than that of IPPV, and with lower peak airway pressure, APRV is more fitter for acute lung injury patients. The influence of hemodynamic of APRV and IPPV is same.

关 键 词：气道压力释放通气 间歇正压通气 心肺功能 

分 类 号：R563.8[医药卫生—呼吸系统]