常用呼吸机模式对脑损伤去骨瓣减压术后继发出血的影响  

The effects of two kinds of commonly used ventilator mode on hemorrhage secondary brain injury after operation

作　　者：周凯[1] 刘济滔[1] 唐鹏[1] 胡沥[1] 黄志远[1] 

机构地区：[1]泸州医学院附属医院急诊科,四川泸州646000

出　　处：《西部医学》2015年第3期405-407,共3页Medical Journal of West China

摘　　要：目的观察两种常用呼吸机模式双水平正压通气（BIPAP）与同步间歇指令通气（SIMV）对脑损伤术后继发出血的影响。方法将76例重型脑外伤患者随机分为BIPAP组与SIMV组各38例,行去骨瓣减压术后入ICU监护治疗,术后6~8h与伤后第1天复查头颅CT,计算脑挫伤灶新增出血量,〉2ml视为有意义变化。同时行血气分析并计算氧合指数、脑氧摄取（CEO2）和脑动静脉氧含量差（Da2-jO2）;比较两种辅助呼吸模式下ICP波动值、脑外伤出血性挫伤扩大例数、氧合指数、CEO2、Da2-jO2。结果治疗组较对照组脑挫伤灶再出血率低,氧合指数、CEO2、Da2-jO2高,死亡率较低,ICP波动值更小（均P〈0.05）。GCS评分、ICP波动值和呼吸机模式对第1个24小时内出血性挫伤再出血有影响。结论 BIPAP模式以其平稳的压力控制,减少继发出血,更适合于重型颅脑损伤术后的辅助通气。Objective To compared the effects of two kinds of commonly used ventilator mode on hemorrhage secondary brain injury after operation of bilevel positive airway pressure（BIPAP）and synchronized intermittent mandatory ventilation（SIMV）.Methods 76 patients with severe traumatic brain injury were randomly divided into group BIPAP and group SIMV.The patients were treated with craniectomy and detected with head CT scans 6 ~ 8h after operation.The volume of new blooding was observed.The oxygenation index,cerebral oxygen uptake（CEO2）and cerebral arteriovenous oxygen content difference（Da2-jO2）were measured.Results The rebleeding rate of treatment group was lower than that of control group.The oxygenation index,CEO2,high Da2-jO2,mortality and ICP fluctuation of treatment group were less than that of the control group.GCS score,ICP and ventilator mode influenced the first 24 hin hemorrhage Conclusion BIPAP mode can reduce the secondary bleeding,which is more suitable for severe brain injury after operation.

关 键 词：脑外伤 呼吸机 BIPAP SIMV 

分 类 号：R651.1[医药卫生—外科学]