压力释放通气在ARDS患者应用.docVIP

压力释放通气在ARDS通气治疗中的应用 罗云鹏 赵鸣雁 蒋磊 王浩然 摘要 目的 评价压力释放通气对ARDS的通气、氧合、血流动力学的影响。方法 ARDS患者19例，随机分为两组，APRV组（n=11）,PCV组（n=8）,两组均用PCV通气30min后取得基础值，再在APRV组通气30min、60min后分别记录两组的通气力学指标、血气指标及血流动力学指标。结果 与PCV组比较，APRV组30min、60min时潮气量Vt、肺动态顺应性Cdya增加，PH、PaO2、PaO2/FiO2升高，PaCO2降低（p＜0.05），虽然平均气道压Pmean较高(P＜0.05）,但是中心静脉压CVP没有多大差异（p＞0.05）,平均动脉压（ABP）、心脏指数（CI）、心率（HR）改善明显（p＜0.05）。结论 ARDS的通气治疗时，当传统通气方法难以达到治疗目标的情况下应用压力释放通气是安全的、可行的，能大大改善通气和氧合，并且对血流动力学的抑制作用反而减小。 关键词：压力释放通气 压力控制通气 急性呼吸窘迫综合征 机械通气 Application of airway pressure release ventilationa in acute respiratory distress syndrome ZHAO Ming-yan JIANG Lei LUO Yun-peng WANG Hao-ran,Intensive Care Unit,First Affiliated Hospital of Harbin Medical University,Harbin150001,China Abstract: Objective To evaluate the effects of airway pressure release ventilation on ventilation、oxygenation、hemodynamics in acute respiratory distress syndrome.Methods Nineteen patients with severe ARDS were ramdomized to receive APRV(n=11) or PCV(n=8). Before beginning ventilation with APRV,all patiens in two groups were ventilated with PCV for 30 minutes to stabilize .In APRV group,Phigh was 30 cmH2O,Plow was 0 cmH2O,Thigh was 4.2s,Tlow was 0.8s;In PCV group,Pinsp was 30cmH2O,Tinsp was 1.5～3.0s,RR was 12 bpm,PEEP was 8～12cmH2O. VT、Pmean、CVP、HR、CI、MAP were continously monitored,and blood gas analysis were measured before APRV (baseline)and 30min、60min after APRV.Sometimes sedation and neuromuscular blockade were needed to aviod the patient –ventilator’s fight.Results Compared with PCV group,tidal volume and lung dynamic compliance were significantly increased in APRV group ;pH、PaO2、PaO2/FiO2 were much higher in APRV group at 30min and 60min.Although mean airway pressure were dramatically higher in APRV group,no big difference in CVP was found between the two groups.MAP、CI、HR were singificantly improved in APRV group at 30min and 60min.Conclusion Airway pressure release ventilation can be applied in ARDS safely and effecti