自动变流速在容量控制通气模式中的应用研究  

The study of AutoFlow role in volume controlled ventilation

作　　者：宋云林[1] 李颖[1] 朱叶苇[1] 窦清理[1] 艾尔肯[1] 柴瑞峰[1] 于湘友[1] 

机构地区：[1]新疆医科大学第一附属医院重症医学科,乌鲁木齐830054

出　　处：《中华危重病急救医学》2013年第6期327-330,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81160232）;新疆医科大学第一附属医院青年科研专项基金（2011N08）

摘　　要：目的监测呼吸机报警次数，评估自动变流速（AutoFlow）在容量控制通气中对患者的疗效和安全性。方法将接受DragerEvita4呼吸机预计机械通气时间〉2d的48例成年患者按随机数字表法分为两组，每组24例。对照组常规给予同步间歇指令通气（SIMV）模式，观察组给予SIMV辅助应用AutoFlow，均持续微量泵入咪达唑仑及芬太尼维持镇静Ramsay评分2～3分。记录呼吸机报警次数、血气分析结果及呼吸参数。结果两组患者机械通气5d内呼吸频率（RR）、潮气量（V_T）、呼气末正压（PEEP）、吸入氧浓度（FiO2）、pH值、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2），以及镇静剂使用剂量和使用时间差异均无统计学意义。所有患者总机械通气时间为164d（3756h），对照组78d（1812h），观察组86d（1944h）；观察组机械通气时间[d，M（范围）]较对照组延长，但差异无统计学意义[3（1—15）比2（1～28），P〉0．05]。所有患者共记录到23843次呼吸机报警，平均6次／h；对照组记录到17386次，平均9．6次／h；观察组记录到6457次，平均33次／h；观察组每小时的呼吸机报警次数少于对照组（P〈0．01），观察组气道压力报警次数明显少于对照组[122（8～1068）比565（13～1898），P〈0．01]。两组患者机械通气1—5d序贯器官衰竭评分（SOFA）无明显差异。观察组有4例发生呼吸机相关性肺炎，无气胸发生，而对照组分别为8例和2例；观察组重症监护病房（ICU）病死率低于对照组，但差异无统计学意义（25．0％比37．5％，P〉O．05）。结论AutoFlow可安全用于容量控制通气模式，同时可以明显减少呼吸机报警的次数。Objective To evaluate the efficacy and safety of automatic variable flow rate （AutoFlow） for volume control ventilation through monitoring the number of ventilator alarm. Methods Forty-eight adult patients receiving the Dr/iger Evita 4 ventilator with an expectation of more than 2 days duration were divided into two groups by randomly digital methods, each n =24. The patients in control group were received routinely mode with synchronized intermittent mandatory ventilation （SIMV）, and the others in observation group were given SIMV and assist with AutoFlow. The midazolam and fentanyl was given to retain the Ramsay score 2-3 by continuous micro-pump. The ventilator alarm, blood gas analysis and respiratory function were recorded. Results There were no significant differences in respiratory rate （ RR ）, tidal volume （VT）, positive end-expiratory pressure （PEEP）, fraction of inspired oxygen （FiO2）, pH, arterial partial pressure of carbon dioxide （PaCO2）, arterial partial pressure of oxygen （PaO2）, oxygenation index （PaO2/FiO2）, as well as sedative dose and time between two groups within 5 days of mechanical ventilation. Duration of mechanical ventilation in all patients was 164 days （3756 hours）, and 78 days （ 1812 hours ） in control group, 86 days （ 1944 hours ） in observation group. The duration of mechanical ventilation [ days, M （range） ] in observation group was longer than that in control group [ 3 （ 1-15 ） vs. 2 （ 1-28 ）, P〉0.05 ]. A total of 23 843 alarms were recorded, approximately 6 times/h, and 17 386 alarms in control group, averagely 9.6 times/h, 6457 alarms in the observation group, averagely 3.3 times/h. The number of ventilator alarm in observation group was less than that in control group （P〈0.01）. The number of airway pressure alarm in observation group was less than that in the control group [ 122（8-1068） vs. 565（ 13-1898 ）, P〈 0.01 ]. There was no significant difference in sequential organ failure assessment （SOFA）

关 键 词：机械通气 自动变流速 呼吸机报警 临床效果 

分 类 号：R614[医药卫生—麻醉学]