异丙酚不同镇静水平对机械通气患者的呼吸动力学及胃肠功能的影响

目的探讨异丙酚不同镇静水平对机械通气患者的呼吸动力学及胃肠功能的影响。方法收集ICU机械通气患者40例，随机分为轻度镇静组和深度镇静组各20例，观察患者呼吸动力学及胃肠功能的变化。结果轻度镇静组和深度镇静组镇静时的吸气潮气量（Vins）、呼气潮气量（Vexp）、分钟通气量（MV）、自主呼吸频率（RRsp）和肺动态顺应性（Cdyn）均较镇静前显著降低（P〈0．05）；而吸气峰压（Ppeak）、平均气道压（Pmean）和气道阻力（Rairway）则较镇静前显著增高（P〈0．01）。深度镇静组镇静时的Vins、Vexp、MV、RRsp和Cdyn较轻度镇静组显著降低（P〈0．01）；而Ppeak、Pmean、和Rairway显著增高（P〈0．01）。深度镇静组镇静后首次肛门排气时间为（27．4±8．2）h，比轻度镇静组时（18．5±6．7）h显著增高（P〈0．01）；轻度镇静后2h和4h的肠鸣音评分比镇静前显著降低（P〈0．01）。深度镇静后2h、4h和6h的肠呜音评分比镇静前显著降低（P〈0．01）。深度镇静组的镇静后2h、4h和6h的肠鸣音评分比轻度镇静组的显著降低（P〈0．01）。结论在机械通气患者中，镇静可抑制机械通气患者的通气功能和改变其呼吸力学特性，还有可能促进胃肠功能障碍的发生和发展；轻度镇静时可改善患者通气方式，同时减少其副作用。

Effect of Propofol on Respiratory Dynamics and Gastrointestinal Function of the Patients Receiving Mechanical Ventilation During Different Sedative Levels

Objective To investigate the effect of propofol on respiratory dynamics and gastrointestinal function of the patients receiving mechanical ventilation during different sedative levels. Methods From June 2005 to June 2006, 40 patients receiving mechanical ventilation were randomly divided into two groups, namely light sedation group and heavy sedation group. The change of respiratory dynamics and gastrointestinal function of the patients were observed. Results （1）The average Vins, Vexp, MV, RRsp and Cdyn were lower in two groups after sedation （ P 〈 0.05）. However the average Ppeak, Pmean and Rairway were higher in two groups （ P 〈0. 01）. （2）Compared to light sedation group, The average Vins, Vexp, MV, RRsp and Cdyn were lower in heavy sedation group in heavy sedation group. However the average Ppeak, Pmean and Rairway were higher （ P 〈0. 01 ）. （3）The anal exsufflation time in heavy sedation group was longer （27.4 ± 8. 2 h）, Compared with the anal exsufflation time of 18.5 ±6.7 h in light sedation group （ P 〈0.01 ）. The borborygmus sound scores were lower in heavy sedation group, compared to light sedation group （ P 〈 0.01 ）. Conclusion The present study confirms propofol can change the respiratory dynamics in the patients receiving mechanical ventilation, and it can cause gastrointestinal disfunction, light sedation can improve the patients＇ respiratory dynamics while reducing it＇s side effect.