不同潮气量对机械通气患者CVP、ITBV、CI等参数的影响  

Study of the effects on the volume parameters when different tidal volume were used on patients treated with mechanical ventilation

作　　者：李军[1,2] 高艳颖[3] 李敏[4] 

机构地区：[1]天津市第三中心医院ICU [2]天津市人工细胞重点实验室,天津300170 [3]天津市第三中心医院消化科,天津300170 [4]河南省人民医院,河南郑州450003

出　　处：《武警医学院学报》2010年第7期523-526,共4页Acta Academiae Medicinae CPAPF

基　　金：天津市卫生局项目(07KZ15)

摘　　要：【目的】比较在机械通气过程中,不同的潮气量、通气模式(BIPAP与SIMV)对患者CVP、ITBV、CI等参数的影响。【方法】选取24例因各种原因需行有创机械通气和PICCO监测的患者,根据CI分为心功能正常组和心功能低下组。在BIPAP模式下,调整吸气压使VT分别维持于6、10、15ml/kg,其他呼吸机支持条件不变,呼吸机模式改为SIMV后,分别调节相同VT水平,以上各种条件维持20min后测量呼吸力学及血流动力学指标。实验过程中以上支持条件随机选择进行。【结果】在心功能正常组,两种呼吸模式下随潮气量增加CI,ITBVI降低,Pmean及PEEPi增加均无明显差异(P值分别为0.067,0.124,0.110,0.187)。在心功能低下组,CI,ITBVI在BIPAP条件下降显著(P=0.036,0.021),在两种呼吸模式下,随潮气量增加CI、ITBVI明显下降,Pmean,PEEPi明显增加;SVRI在15ml/kg与6ml/kg组间有统计学差异,两种模式CVP、HR均无明显变化。【结论】两种模式随着潮气量水平的升高,CI及ITBVI均明显下降,尤以衰竭心脏者为甚。CVP则无明显变化。因此,在机械通气应用PICCO评估容量参数中,应考虑心功能及潮气量对CI、ITBVI的影响。[Objective] To compare the effects on homodynamics when different ventilation modes were used on patients treated with mechanical ventilation. [ Methods] Twenty-four patients treated with invasive mechanical ventilation because of various reasons, and hemodynamics was monitored with PICCO, were divided into normal cardiac function group and poor cardiac function group according to the cardiac index （C I）. 20 minutes later, the parameters of breathing mechanics and hemodynamics were monitored with different selected tidal volume levels of 6ml/kg, 10ml/kg, 15ml/kg under biphasic positive airway pressure （BIPAP） mode by changing the pressure of inspiration ,then the same parameters were monitored again with the same level of tidal volume and support conditons under the SIMV mode. The support conditions above were random selected in the experiment. [ Results] In the normal cardiac function group, in both ventilation modes the increase in tidal volume led to a decrease of CI and ITBVI, an increase of Pmean and PEEPi, but there was no significant different between BIPAP and SIMV mode（P=0.067,0.124,0.110,0.187）. In the poor cardiac function group, in both ventilation modes the increase in tidal volume led to a decrease of CI and ITBVI, especially under BIPAP mode（P=-0.036,0.021）,an increase of Pmean and PEEPi, but it had no significant effects on CVP,HR, there was statistics difference of SVRI with the tidal volume levels of 15ml/kg and 6ml/kg. [ Conclusions ] In both ventilation modes, the increase in tidal volume led to a decrease of CI and ITBVI, especially in the heart failure patients. So, the effects of cardiac function and tidal volume on CI and ITBVI should be considered when hemodynamics was monitored with PICCO in patients treated with mechanical ventilation.

关 键 词：中心静脉压 心脏指数 胸内血容量 呼吸模式 潮气量 

分 类 号：R332[医药卫生—人体生理学]