心肺复苏持续胸外心脏按压时呼吸机潮气量与气道高压报警值设置的研究  

Study of setting of ventilator volume tidal and airway pressure alarm threshold with continuous extra- sternum heart compression in cardiopulmonary resuscitation

作　　者：罗建宇[1] 王晓源[1] 蔡天斌[1] 蒋文芳[1] 

机构地区：[1]柳州市人民医院ICU,广西545006

出　　处：《中华危重病急救医学》2013年第2期102-105,共4页Chinese Critical Care Medicine

摘　　要：目的研究持续胸外心脏按压时设置呼吸机不同潮气量（VT）与气道高压报警值对心肺复苏（CPR）效果的影响。方法将重症医学科中40例呼吸、心搏骤停患者按随机数字表法均分为小VT通气组与常规VT通气组。两组均采用容量控制模式，小VT通气组CPR开始后呼吸机VT设置为6—7ml／kg，高压报警值由40cmH2O（1cmH2O=0．098kPa）上调至60cmH2O；常规VT通气组CPR开始后VT值和高压报警值均保持不变（VT8-12ml／kg，高压报警值40cmH2O）。观察对比CPR过程中呼吸机实测VT、吸气峰压（PIP），10min、30min时血气分析和血乳酸，以及并发症发生情况。结果CPR 10min后小VT通气组动脉血气分析中的5项指标[pH值、血氧分压（PaO2，mmHg，1mmHg=0．133kPa）、血二氧化碳分压（PaCO2，mmHg）、HCO3-（mmol／L）、血氧饱和度（SaO2）]及血乳酸（mmol／L）均优于常规VT通气组（pH值：7．21±0．09比7．13±0．07，PaO2：45．35±5．92比40．70±4．70，PaCO2：57．10±7．59比61．60±5．47，HCO3-：18．50±3．50比14．75±2．65，SaO2：0．796±0．069比0．699±0．066，乳酸：7．07±1．60比8．13±1．56，均P〈0．05）。小VT通气组复苏成功率较常规VT通气组高（45％比15％，P〈0．05）；PIP（cmH2O）较常规VT通气组低（37．25±7．99比42．70±7．40，P〈0．05）；两组均未发现气压伤。结论CPR时呼吸机设置小VT（6～7ml／kg）并适当上调气道高压报警值比常规VT通气方法效果更好，且气压伤发生率未见明显增加。Objective To investigate the setting of ventilator volume tidal （VT） and airway pressure alarm threshold during cardiopulmonary resuscitation （CPR） by continuous extra-sternum heart compression. Methods Forty cases with respiration and cardiac arrest in the department of critical care medicine were randomly divided into low VT ventilation group and conventional VT group. Both groups were given the volume control mode. In the low VT ventilation group, VT was set on 6 - 7 ml/kg, and high pressure alarm threshold was adjusted to 60 cm H2O （1 cm H2O =0.098 kPa） by the conventional 40 cm H2O during CPR. In the conventional VT group, VT and high pressure alarm threshold were set at 8 - 12 ml/kg and 40 cm H2O, respectively. Real-time actual VT, peak inspiratory pressure （PIP）, and arterial blood gas test, blood lactic acid at 10 minutes and 30 minutes after CPR were observed. Results At 10 minutes after CPR, in the low VT ventilation group, arterial blood pH, arterial partial pressure of oxygen （PaO2, mm Hg, 1 mm Hg =0.133 kPa）, arterial partial pressure of carbon dioxide （PaCO2, mm Hg）, HCO3- （mmol/L）, arterial oxygen saturation （SaO2） and blood lactic acid （mmol/L） were better as compared with those in the conventional VT ventilation group （pH： 7.21 ± 0.09 vs. 7.13 ± 0.07, PaO2：45.35 ± 5.92 vs. 40.70 ± 4.70, PaCO2： 57.10 ± 7.59 vs. 61.60 ± 5.47, HCO3 ： 18.50 ± 3.50 VS. 14.75 ± 2.65, SaO2：0.796 ± 0.069 vs. 0.699 ± 0.066, blood lactic acid： 7.07 ± 1.60 vs. 8.13 ± 1.56, all P〈0.05）. The success rate of resuscitation in the low VT ventilation group was higher than that of the conventional VT ventilation group （45% vs. 15%, P〈0.05 ）, and PIP （cm H2O ） of low VT ventilation group was lower than that of the conventional VT group （37.25 ± 7.99 vs. 42.70 ± 7.40, P〈0.05 ）. In all the patients in both groups barotrauma did not occur. Conclusion The strategy of low ventilator VT （6 - 7 ml/kg） with appropriate elevation of airway pressure alarm

关 键 词：心肺复苏 呼吸机 潮气量 气道高压 

分 类 号：R459.7[医药卫生—急诊医学]