三种呼吸模式对慢性阻塞性肺疾病合并呼吸衰竭患者周围循环和血气分析的影响  

Effects of Three Modes of Breathing on Peripheral Circulation and Blood Gases in Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

作　　者：刘新茹[1] 贾红光[1] 付爱双[1] 安立红[1] 陈桂芝[1] 王红阳[1] 

机构地区：[1]河北联合大学附属医院,河北省唐山市063000

出　　处：《中国全科医学》2012年第28期3261-3263,共3页Chinese General Practice

摘　　要：目的探讨比较辅助控制呼吸模式(A/C)、同步间歇指令通气(SIMV)和压力支持通气(PSV)三种呼吸模式对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者周围循环和血气分析的影响。方法对42例COPD合并呼吸衰竭患者行有创机械通气。最初采用A/C,逐步更改为SIMV和PSV,三种模式各持续120 min。SIMV指令为A/C的75%,PSV压力设置与A/C呼出潮气量为基本相同的水平。每隔15 min记录呼吸机参数、心率和血压1次。每隔60min测中心静脉压(CVP)、血气分析1次。结果 SIMV、PSV与A/C吸气峰值压(PIP)分别为(26.25±2.41)、(21.66±2.15)、(32.49±3.46)cm H2O,三者间差异均有统计学意义(F=14.446,P<0.05),SIMV、PSV与A/C比较PIP降低,差异均有统计学意义(q=3.12、3.61,P<0.05)。SIMV、PSV与A/C收缩压(SBP)分别为(126.21±14.06)、(124.22±10.56)、(148.26±12.08)mm Hg,舒张压(DBP)分别为(78.91±12.30)、(76.78±10.88)、(90.86±10.23)mm Hg,CVP分别为(10.18±1.26)、(9.00±2.87)、(13.25±2.10)cm H2O,三者间SBP、DBP、CVP差异均有统计学意义(F=19.675、18.564、16.571,P<0.05),SIMV与A/C比较SBP、DBP、CVP差异均有统计学意义(q=3.29、2.85、2.79,P<0.05),PSV与A/C比较SBP、DBP、CVP差异均有统计学意义(q=3.43、2.82、3.04,P<0.05)。SIMV、PSV与A/C动脉血氧分压(PaO2)分别为(108.01±3.18)、(100.23±2.81)、(92.63±2.83)mm Hg,血氧饱和度(SaO2)分别为(97.35±1.81)、(97.26±1.52)、(92.23±1.26)%,三者间PaO2、SaO2差异均有统计学意义(F=11.563、10.364,P<0.05),SIMV、PSV与A/C比较PaO2、SaO2差异均有统计学意义(q=3.08、3.61;q=3.20、3.59,P<0.05)。结论 COPD合并呼吸衰竭应用有创机械通气,SIMV和PSV优于A/C。Objective To observe and compare the effects of three kinds of breathing modes of auxiliary control breathing pattern （A/C）, synchronized intermittent mandatory ventilation （SIMV）, and pressure supported ventilation （PSV） on peripheral circulation and blood gases in chronic obstructive pulmonary disease （COPD） complicated with respiratory failure. Methods Totally 42 COPD patients complicated with respiratory failure were given invasive mechanical ventilation, first the A/ C, then SIMV and PSV, 120 min for each modes. The SIMV instruction was 75% of A/C, and the exhaled tidal volume of PSV pressure settings was substantially at the same level of A/C. The parameters of respirator, heart rate and blood pressure were recorded once every 15 min, and the central venous pressure （CVP） and blood gas analysis were measured once every 60 min. Results The peak inspiratory pressures （PIP） of SIMV, PSV and A/C were respectively （ 26. 25 ± 2.41 ）, （ 21.66 ± 2. 15） and （32. 49 ±3.46） cm H20, with a significant difference （F = 14. 446, P 〈0.05）. The PIPs of SIMV and PSV were lower than that of A/C （q = 3.12, 3.61, P 〈 0. 05）. The systolic blood pressures （SBP） of SIMV, PSV and A/C were （ 126. 21 ± 14.06）, （ 124. 22 ± 10. 56）, and （ 148. 26 ± 12. 08） mm Hg, respectively, the former two were lower than the lat- ter ; their diastolic blood pressures （DBP） were （78. 91 ± 12. 30） , （76. 78 ± 10. 88 ） and （90. 86 ± 10. 23 ） mm Hg respectively; the CVPs were （10. 18 ± 1.26）, （9. 00±2. 87） and （ 13.25 ±2. 10） cm H20; the differences in SBP, DBP and CVP among the three modes were statistically significant （F = 19.675, 18. 564, and 16. 571, P 〈 0. 05 ）. The differences in SBP, DBP, and CVP between SIMV and A/C showed statistical significant （q = 3.29, 2. 85, 2. 79, P 〈 0.05） ; and the differences in SBP, DBP, and CVP between PSV and A/C showed statistical significant （ q = 3.43, 2. 82, 3.04, P 〈 0.05 ）. The PaO2 values

关 键 词：肺疾病 慢性阻塞性 呼吸模式 周围循环 血气分析 

分 类 号：R563[医药卫生—呼吸系统]