压力调节容量控制通气模式对先心病术后合并ARDS患儿肺顺应性及氧合功能影响  

Effect of pressure regulation volume control ventilation mode on lung compliance and oxygenation function in children with ARDS after congenital heart disease

作　　者：张媛媛[1] 庞秋贺 ZHANG Yuan-yuan;PANG Qiu-he(Henan Provincial Peoples Hospital,Children's Heart Center Intensive Care Unit,Fuwai Hua Central Vascular Disease Hospital,Zhengzhou 451450,China)

机构地区：[1]河南省人民医院,阜外华中心血管病医院儿童心脏中心重症监护室,郑州451450

出　　处：《医药论坛杂志》2023年第18期19-22,27,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220136)。

摘　　要：目的 分析压力调节容量控制(pressure regulation volume control, PRVC)通气模式机械通气治疗先天性心脏病(以下简称先心病)手术后并发呼吸窘迫综合征(ARDS)患儿的效果。方法 将河南省人民医院2021年1月至2022年5月收治的40例先心病术后合并ARDS患儿为研究对象,均接受呼吸机治疗,随机分为观察组和对照组,观察组采用PRVC,对照组则采取同步间歇指令通气(SIMV),用呼吸频率(RR)、潮气量(TV)、达峰时间比(TPTEF/Te)及肺顺应性作为呼吸功能指标,参与对比的呼吸机参数有气道峰压(PIP)及平均气道压(MAP),血气分析结果选择酸碱值(pH)、血氧分压(PaO_(2))及氧合指数(OI),比较肺毛细血管楔压(PAWP),并进行机械通气时间、吸氧时间、住院时间及相关并发症对比。结果 上机后72 h,观察组RR及PIP、MAP均低于对照组,TV、TPTEF/Te、肺顺应性均高于对照组,且PaO_(2)、OI亦高于对照组(P<0.05),PAWP及机械通气时间则低于对照组(P<0.05),两组pH、住院时间、用氧时间及并发症发生率无统计学意义(P>0.05)。结论 先心病术后并发ARDS的患儿应用呼吸机治疗时可优先考虑PRVC模式,该模式能保留患儿自主呼吸,减少压力及容量损伤,不仅能有效提高肺顺应性、改善氧合情况、缓解缺氧状态,还利于患儿肺功能的恢复。Objective To analyze the effect of pressure regulation volume control(PRVC)ventilation mode mechanical ventilation in the treatment of children with ARDS after congenital heart disease surgery.Methods A total of 4O children with ARDS after congenital heart disease surgery admitted to our hospital from January 2021 to May 2022 were studied.All patients received ventilator treatment and were randomly divided into observation group and control group.The observation group received PRVC,while the control group received synchronous intermittent command ventilation(SIMV).Respirato-ry rate(RR),tidal volume(TV),peak-to-peak ratio(TPTEF/Te)and lung compliance were used as indicators of re-spiratory function.Ventilator parameters involved in the comparison were PIP and MAP,and pH,partial oxygen pressure(PaO_(2))and oxygenation index(OI)were selected as blood gas analysis results.Pulmonary capillary wedge pressure(PAWP)was compared,and mechanical ventilation time,oxygen duration,hospital stay and related complications were compared.Results 72 h after implantation,RR,PIP and MAP in observation group were lower than those in control group,TV,TPTEF/Te and lung compliance were higher than those in control group,PaO_(2) and OI were also higher than those in control group(P<0.05),PAWP and mechanical ventilation time were lower than those in control group(P<0.05).There were no significant differences in pH,length of hospital stay,oxygen use time and incidence of compli-cations betweenthetwogroups(P>0.05).Conclusion PRVC mode should be given priority in the application and ventilator treatment of ARDS patients after congenital heart disease surgery.This mode can preserve the spontaneous respiration of children,reduce pressure and volume damage,and can not only effectively improve lung compliance,improve oxygenation and relieve hypoxia,but also facilitate the recovery of lung function in children.

关 键 词：呼吸窘迫综合征 压力调节容量控制 肺顺应性 并发症 

分 类 号：R541[医药卫生—心血管疾病]