气道压力释放通气模式对严重创伤患者胃黏膜pH的影响  

Effect of airway pressure release ventilation mode on gastric intramucosal pH in patients with severe trauma

作　　者：邵劲松[1] 周立新[1] 誉铁鸥[1] 周锦平 曹俊 Shao Jinsong;Zhou Lixin;Yu Tieou;Zhou Jinping;Cao Jun(Department of Intensive Care Unit, the First People′s Hospital of Foshan, Foshan 528000, China)

机构地区：[1]佛山市第一人民医院重症医学科,528000

出　　处：《国际呼吸杂志》2019年第15期1157-1162,共6页International Journal of Respiration

摘　　要：目的动物实验研究已经证实气道压力释放通气(APRV)能改善胃肠血流,本研究探讨其对严重创伤患者胃黏膜pH(pHi)及非肠道术后患者胃肠功能的影响。方法选择60例需机械通气严重创伤患者[创伤严重程度(ISS)评分≥16分]。所有入选病例在试验开始前首先行机械通气(CMV)6 h为平衡期,后随机分为APRV和同步间歇指令通气(SIMV)两组。患者入ICU后将胃肠张力计导管插入患者胃内,用Tonocap监护仪测定胃黏膜二氧化碳分压(PgCO2),同时将动脉血血气分析测的pH值和PaCO2值输入Tonocap监测仪自动计算PgCO2与PaCO2的差值(Pg-aCO2)及胃黏膜pH(pHi)。记录患者达平衡期(T0)、平衡期后8 h(T1)及16 h(T2)血气分析、呼吸力学及胃肠灌注等相关指标。非肠道术后患者记录出现肛门排气时间及排便时间。结果每组患者各30例。两组患者急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分和ISS评分入组时差异无统计学意义,在机械通气6 h平衡期后记录的参数指标差异无显著统计学意义;8 h、16 h动脉血气分析指标提示均出现氧合指数改善趋势;而APRV组有更低的气道峰压和平均压。pHi在APRV组通气后16 h明显升高(7.297±0.046比7.249±0.080,P<0.01);而乳酸(Lac)在APRV组通气16 h后差异有统计学意义(2.3±1.0比2.6±1.8,P<0.05)。进一步相关分析显示pHi和Lac在两组中均呈负相关。非肠道术后患者APRV组25例、SIMV组21例,APRV组肛门排气时间及排便时间明显短于SIMV组[(39.8±9.3) h比(46.2±10.6) h,P<0.05及(68.6±13.1) h比(79.3±16.4) h,P<0.05]。结论气道压力释放通气能够改善严重创伤患者氧供及胃肠道血供、促进胃肠功能的恢复。Objective Animal experimental studies have confirmed that airway pressure release ventilation (APRV) can improve gastrointestinal blood flow.This study investigated its effects on gastric intramucosal pH (pHi) and gastrointestinal function after parenteral surgeryin severe trauma patients. Methods Sixty severe trauma [injury severity score (ISS) score≥16] patients with mechanical ventilation were selected.Controlled ventilation mode was performed for 6 hours before the trials started in all patients, and then they were randomly divided into APRV or synchronized intermittent mandatory ventilation (SIMV) groups.After the patient administered to the ICU, the gastrointestinal tonometer catheter was inserted into the patient′s stomach, and the gastric carbon dioxide partial pressure (PgCO2) was measured by the Tonocap monitor.At the same time, the measured pH and PaCO2 value by arterial blood gas analysis were input into the Tonocap monitor to automatically calculate the difference (Pg-aCO2) between PgCO2 and PaCO2 and pHi.Parameters of blood gas analysis, respiratory mechanics and gastrointestinal perfusion were recorded in the stability period (T0), 8 hours (T1) and 16 hours (T2) after the equilibrium period.Patients with non-enteric surgery recorded anal exhaust time and defecation time. Results There were 30 patients in each group.The differences on acute physiology and chronic health evaluation Ⅱ(APACHE) score and ISS score between two groups were not statistically significant at the time of study entry.The differences on the parameters recorded after the 6-hour equilibrium period of mechanical ventilation were not statistically significant.Arterial blood gas analysis parameters showed that the oxygenation index were improved at 8 hour and 16 hour, while the APRV group had lower airway peak pressure and mean pressure.PHi at 16h after APRV were 7.297±0.046 vs 7.249±0.080, P<0.01.While the differences on lactate (Lac) at 16 h after APRV were not statistically significant (2.3±1.0 vs 2.6±1.8, P<0.05). Furt

关 键 词：通气机 机械 呼吸窘迫综合征 成人 气道压力释放通气 创伤 胃黏膜PH 

分 类 号：R641[医药卫生—外科学] R563.8[医药卫生—临床医学]