压力调整容量控制通气在腹腔间隔室综合征中的应用研究  

Effect of Pressure- regulated Volume Control Ventilation Mode on Patients With Abdominal Compartment Syndrome

作　　者：尹江涛[1] 万兵[1] 孙志伟[1] 

机构地区：[1]江苏大学附属医院ICU,江苏省镇江市212001

出　　处：《中国全科医学》2016年第12期1477-1481,共5页Chinese General Practice

基　　金：镇江市科技支撑计划(社会发展)资助项目(SH2013037)

摘　　要：目的探讨常规容量控制(VC)通气和压力调整容量控制(PRVC)通气对腹腔间隔室综合征(ACS)患者通气效果的影响。方法选取2011年5月—2014年5月江苏大学附属医院ICU收治的ACS患者36例,均行机械通气治疗,采用随机数字表法分为两组:A组19例采用同步间歇指令-容量控制(SIMV-VC)模式,B组17例采用同步间歇指令-压力调整容量控制(SIMV-PRVC)模式,采集两组患者第1天、第3天及第5天血气分析指标、呼吸力学指标、血流动力学指标及序贯器官衰竭估计评分(SOFA评分)。结果 A组与B组患者不同时间动脉血氧分压(Pa O2)、氧合指数(Pa O2/Fi O2)、吸气峰压(PIP)、肺静态顺应性(Cst)比较,存在交互作用(P<0.05);A组与B组患者不同时间动脉血二氧化碳分压(Pa CO2)、肺泡-动脉氧分压差(A-a DO2)、气道平均压(Pmean)、气道阻力(R)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、SOFA评分比较,不存在交互作用(P>0.05);组间Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、Pmean、Cst、R、CVP、SOFA评分比较,差异有统计学意义(P<0.05);组间PIP、HR、MAP比较,差异无统计学意义(P>0.05);不同时间间Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、PIP、Pmean、Cst、R、MAP、CVP、SOFA评分比较,差异有统计学意义(P<0.05);不同时间间HR比较,差异无统计学意义(P>0.05)。结论 SIMV-PRVC模式机械通气治疗ACS患者,可明显改善Pa O2、Pa CO2、A-a DO2、Pa O2/Fi O2、Pmean、Cst、R、CVP、SOFA评分,符合肺保护性通气策略的要求。Objective To compare the effects of mechanical ventilation between conventional ventilation mode of volume control（VC）and pressure - regulated volume control（PRVC）ventilation mode on patients with abdominal compartment syndrome（ACS）. Methods A total of 36 patients with ACS who were admitted into the Department of ICU of the Affiliated Hospital of Jiangsu University between May 2011 to May 2014 were enrolled. By random number table method,the patients were divided into two groups. There were 19 patients who were assigned into group A where SIMV-VC was used;the others 17 patients were assigned to group B where SIMV-PRVC was used. The data of artery blood gas analysis, respiratory mechanics, hemodynamics and sequential organ failure assessment score（SOFA score）were collected on the first day,the third day and the fifth day. Results Interaction effect existed between group A and group B and among different time points in PaO2 ,PaO2 / FiO2 , PIP and Cst（P 〈 0. 05）;no interaction effect existed between group A and group B and among different time points in PaCO2 , A-aDO2 ,Pmean,R,HR,MAP,CVP and SOFA score（ P 〉 0. 05）. The two groups were significantly different in PaO2 , PaCO2 ,A-aDO2 ,PaO2 / FiO2 ,Pmean,Cst,R,CVP and SOFA score（ P 〈 0. 05）,but were not significantly different in PIP,HR and MAP（P 〉 0. 05）. Significant differences existed in PaO2 ,PaCO2 ,A-aDO2 ,PaO2 / FiO2 ,PIP,Pmean,Cst, R,MAP,CVP and SOFA score at different time points（P 〈 0. 05）,while no significant differences existed in HR at different time points（ P 〉 0. 05）. Conclusion PRVC can increase PaO2 ,PaCO2 ,A-aDO2 ,PaO2 / FiO2 ,Pmean,Cst,R,CVP, SOFA score of ACS patients undergoing mechanical ventilation,which fits the requirements of lung protective ventilation strategy.

关 键 词：腹内高压 压力调整容量控制 通气 机械 呼吸力学 血气分析 血流动力学 

分 类 号：R619[医药卫生—外科学]