成人机械通气行纤维支气管镜操作时常规通气模式选择  

Study on choosing conventional ventilation modes in adult mechanical ventilated patients during fiberoptic bronchoscopy procedure

作　　者：王启星[1] 张翔宇[1] 杨自建[1] 蒋欣[1] 陈亮[1] 

机构地区：[1]同济大学附属第十人民医院急诊重症医学科,上海200072

出　　处：《同济大学学报（医学版）》2009年第4期116-119,共4页Journal of Tongji University(Medical Science)

摘　　要：目的探讨行机械通气的成人患者经人工气道进行纤维支气管镜(fiberoptic bronchoscopy,FOB)操作时,压力控制性通气(pressure control ventilation,PCV)和容量控制性通气(volume control ventilation,VCV)模式下纤维支气管镜操作对患者呼吸力学、血流动力学的影响。方法所有入组患者均为行有创机械通气及具有纤维支气管镜操作指征,对其设置不同的通气模式和参数。采用自身前后对照的方法,在基本生命体征和血流动力学稳定的情况下,不脱离呼吸机,经Y型管与患者气管导管之间的三通接头进行纤维支气管镜操作。同时监测纤维支气管镜操作前、过程中、操作后2 h患者基础潮气量(basic tidal volume,VTbasic)、最小输送潮气量(minimize tidal volume,VTmin)、最大输送潮气量(maximum tidal volume,VTmax)、气道峰压(peak inspiratory pressure,PIP)、心率(heart rate,HR)、动脉血压(arterial blood pressure,ABP)、动脉血气分析等指标。结果纤维支气管镜操作过程中,PCV较VCV相比,PCV模式下,[PIP(2.09±0.25)kPa]显著降低,而VTmin[(89.8±18.6)ml]、VTmax[(994.6±126.8)ml]显著增高(P<0.05)。所有行FOB操作的患者PCV和VCV模式下与操作前比较,HR、ABP、SpO2显著增高(P<0.05);与操作前相比,所有患者在纤维支气管镜操作2 h后,SpO2[(98.0±0.9)%]、PaO2[(18.74±3.44)kPa]显著升高(P<0.05),PaCO2[(4.87±0.56)kPa]显著降低(P<0.05),HR、ABP上无显著差异性(P>0.05);纤维支气管镜操作2 h后PCV模式与VCV模式比较,HR、ABP无显著差异性(P>0.05)。结论成人机械通气患者行纤维支气管镜操作时,在机械通气常规通气模式的选择上,PCV比VCV可提供更多的呼出潮气量,两种模式下HR、ABP均有增加。Objective To explore the effects of pressure control ventilation（PCV）and volume control ventilation（VCV） modes on respiratory mechanics and hemodynamics in adult mechanical ventilated patients during fiberoptic bronchoscopy（FOB） procedures.Methods All patients underwent mechanical ventilation and FOB procedures,setting different ventilation modes and parameters.When basic vital signs and hemodynamics were stable,FOB was introduced using a cross-over method and through a three-way connector between the Y-piece and the patient＇s tracheal tube（including endotracheal tube and tracheostomy tube）,without disconnecting the ventilator.At the same time,the parameters before,during and after FOB procedures were monitored,including peak inspiratory pressure（PIP）,basic tidal volume（VTbasic）,minimal tidal volume（VTmin）,maximum tidal volume（VTmax）,heart rates（HR）,arterial blood pressure（ABP）,arterial blood gas analysis,etc.Results Compared with VCV,PCV had lower PIP[（2.09±0.25）kPa],delivering increased VTmin[（89.8±18.6）ml] and VTmax[（994.6±126.8）ml]（P〈0.05）.During the FOB procedures,all the patients showed,in both PCV and VCV modes,significant increase（P〈0.05） in HR,ABP and SpO2 as compare with those before the procedures;showed significant increase（P〈0.05） in SpO2[（98.0±0.9）%] and PaO2[（18.74±3.44）kPa] 2 hours after the FOB procedures as compared with those before the procedures;and showed significant decrease（P〈0.05） in PaCO2[（4.87±0.56）kPa] 2 hours after the procedure as compared with those before the procedures.In comparison of PCV mode with VCV mode,HR and ABP showed no significant difference（P〉0.05）.Similarly,HR and ABP showed no significant difference（P〉0.05） 2 hours after the FOB procedure as compared with those before the procedure.Conclusion The application of fiberoptic bronchoscopy in adult mechanically ventilated patients,pressure control mode can deliver higher tidal volume than volume control mode,but HR a

关 键 词：机械通气 纤维支气管镜 通气模式 

分 类 号：R562[医药卫生—呼吸系统]