根据 PV线选择理想潮气量对急性肺损伤病人的临床意义.docVIP

根据 PV曲线选择理想潮气量对急性肺损伤病人的临床意义 作者：王爱敏 作者单位：青岛大学医学院，山东 青岛 266021 【摘要】 目的 探讨使用呼吸机时不同潮气量对急性肺损伤病人血流动力学和肺机械力学参数、肺通气的影响。方法 采取自身对照法，用压力容积(PV)曲线下拐点+0.196 kPa确定呼气末正压(PEEP)后，再根据PV曲线的上拐点(VUIP)对应潮气量(Vt )分别给予16例急性肺损伤病人100%Vt、85%Vt和70%Vt ，以相同的分钟通气量和吸入氧浓度分别给予定容机械通气，监测肺机械力学和血流动力学参数、血气改变及PV曲线的变化。结果 与100%Vt组相比，85%Vt组、70%Vt组心率、CVP降低，差异有显著性(F=3.894、6.305,q=3.784～4.978，P 0.05);而85%Vt组和70%Vt组比较差异无显著性(P 0.05)。3组PaO2、PaO2/FiO2 比较，85%Vt组最高，70%Vt组最低;3组PaCO2比较，70%Vt组最高，100%Vt组最低，差异有显著性(F=5.138～53.770,q=3.496～4.773，P 0.05)。与100%Vt组比较，85%Vt组和70%Vt组的PIP、Pm明显减少，Cst明显升高，差异均有显著性(F=13.260～56.130，q=3.879～10.072，P 0.05)。结论 以呼吸系统PV曲线的下拐点确定PEEP值，以上拐点压力对应的潮气量的85%调节潮气量符合个体化保护性通气策略，对改善肺的顺应性、降低肺病理性损伤效果较好。 【关键词】 呼吸窘迫综合征 成人 PV曲线 肺通气 潮气量 CHOOSING IDEAL TIDAL VOLUME BASED ON PRESSUREVOLUME CURVE: ITS CLINICAL SIGNIFICANCE FOR PATIENTS WITH ACUTE LUNG INJURYWANG AIMIN, SUN YUNBO, SHEN YI, et al(Nursing College of Qingdao University Medical College, Qingdao 266021, China) [ABSTRACT]ObjectiveTo study the influence of different tidal volumes on hemodynamics,lung ventilation and pulmonary mechanics in patients with acute lung injury during mechanical ventilation.MethodsA selfcontrol study was done on 16 patients with acute lung injury. The VlIP+0.196 kPa of PV curve was used to determine PEEP. Three different humidity (100%Vt, 85% Vt and 70 %Vt) obtained according to the VUIP of PV curve were given to the patients, at the same time, changes of static compliance, hemodynamics and PV curve were monitored.ResultsCompared with 100%Vt group, the heart rate and CVP of 85%Vt and 70%Vt groups were significantly lower (F=3.894,6.305;q=3.784-4.978;P 0.05); There were no significant differences in heart rate and CVP between 85%Vt and 70%Vt groups. Of the three groups, 85%Vt group had the highest PaO2 and PaO2/FiO2 values, while 70%Vt group had the lowest PaO2 and PaO2/FiO2. Concerning PaCO2, 70%Vt group showed the highest value, while 100%Vt group showed the lowest, the difference was significant (F=5.138