吸气压力支持通气在机械通气中应用的临床观察  

Clinical application of inspiratory pressure support ventilation in mechanically ventilated patients

作　　者：王士泳[1] 秦英智[1] 魏肃[1] 徐磊[1] 徐荣和[1] 孙惠军[1] 

机构地区：[1]天津市第三中心医院ICU

出　　处：《中国危重病急救医学》1999年第2期84-86,共3页Chinese Critical Care Medicine

摘　　要：目的：探讨采用吸气压力支持（ＩＰＳ）通气时压力支持（ＰＳ）水平与潮气量（ＶＴ）、呼吸频率（ｆ）、闭合压（Ｐ０．１）和血气分析（ＢＧＡ）的关系，以及如何选择适宜的ＰＳ水平成功地预测脱机的方法。方法：采用对照研究的方法将３４例机械通气患者按最终是否经ＩＰＳ脱机成功分为２组：脱机成功组２５例，ＡＰＡＣＨＥⅡ记分平均（２５．４±５．４）分；脱机失败组９例，ＡＰＡＣＨＥⅡ记分平均（３０．２±５．２）分。每８小时或改变ＰＳ水平后记录ＶＴ、ｆ、Ｐ０．１、经皮氧饱和度（ＳｐＯ２），每日查ＢＧＡ。结果：ＩＰＳ脱机成功率７４％（２５／３４）。脱机时ＰＳ＜０．６９ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），Ｐ０．１＜０．３９ｋＰａ。机械通气＜１４日者，用ＩＰＳ０．５～２日后结合常规参数指标很容易脱机；超过１４日带机者，用ＩＰＳ３～７日可脱机，脱机指标除常规参数外还应结合Ｐ０．１的动态观察，ＰＳ常需降至０．３９～０．５９ｋＰａ，结合ｆ、Ｐ０．１及ＶＴ调整ＰＳ水平。结论：ＩＰＳ作为患者触发呼吸机的一种辅助通气方式，结合Ｐ０．１监测能提供最佳ＰＳ水平，并能较早地成功预测脱机。Objective:To investigate the relationship between pressure support (PS) level and tidal volume (V T),frequency (f),occlusion pressure (P 0 1 ),as well as blood gas analysis (BGA) when the mode of inspiratory pressure support (IPS) was applied.Also,the present study was performed to assess how to regulate PS level and how to predict weaning success.Methods:According to whether or not weaning success,34 mechanically ventilated patients were divided into two groups:weaning success ( n= 25) and weaning failure ( n =9). APACHE Ⅱ scores were 25 4±5 4 and 30 2±5 2 in patients with and without weaning success respectively,V T,f,P 0 1 ,SpO 2 were recorded every 8 hours or when PS level was changed,and BGA was determined each day.Results:Successful rate of weaning from IPS was 74% (25/34 cases).PS and P 0 1 levels were less than 0 69 kPa ( 1 kPa = 10 20 cmH 2O ) and 0 39 kPa while weaning from mechanical ventilation (MV).When the period of MV lasted for less than 14 days,it was very easy that IPS with conventional parameters weaned from MV.However,mechanically ventilated period lasted for more than 14 days,weaning from IPS was needed 37 days.Besides conventional parameters,dynamic observation should be combined with P 0 1 .PS level was always lowered to 0 390 59 kPa,it could be regulated according to changes in f,P 0 1 ,as well as V T.Conclusions:IPS as a trigger respirator for patients is assistant ventilated mode.During pressure support ventilation,dynamic observation of P 0 1 would be predict weaning successfully earlier.

关 键 词：IPS 机械通气 脱机 压力支持通气 PS 

分 类 号：R459.7[医药卫生—急诊医学] R605.973[医药卫生—治疗学]