压力控制通气和容量控制通气模式在ARDS治疗中的比较

目的:探讨急性呼吸窘迫综合征(ARDS)压力控制通气(PCV)和容量控制通气(VCV)模式对患者呼吸力学、血气及血流动力学的影响及临床意义。方法:40例ARDS患者按随机表法分为PCV组和VCV组进行机械通气治疗,均实行肺保护通气策略,比较两组患者呼吸力学、血气及血流动力学各指标的变化。结果:PCV组通气24h气道峰压低于VCV组,而平均气道压高于VCV组;两组治疗后心率显著减慢,PCV组改善更明显;两组同时点平均动脉压比较差异均无显著性;治疗24h后PaO2比治疗前均明显升高,PCV组改善更明显。结论:对ARDS患者在实行肺保护通气策略时,PCV和VCV通气模式均可改善氧合,防止气压伤的发生,对患者血流动力学影响小,PCV模式控制气道峰压更有效;主张ARDS患者尽量采用PCV模式实行肺保护通气策略。

Treament of acute respiratory distress syndrome using pressure and volume controlled ventilation

Objective:To investigate the significance and effect of pressure controlled ventilation(PCV)as well as volume controlled ventilation(VCV) on blood gas analysis and hemodynamics in patients with acute respiratory distress syndrome(ARDS).Methods:Fouty patients with ARDS were randomly divided into PCV and VCV groups,the blood gas analysis and hemodynamics were compared between two groups.Results:The peak inspiration pressure(PIP)in PCV group was significantly lower than that in VCV group,while the mean pressure of airway(Mpaw) was signficantly higher than that in VCV after 24 hours mechanical ventilation.After 24 hours mechanical ventilation,there was slower heart rate(HR) in two groups,and PCV group had slower HR than VCV group,the two groups had no difference in mean blood pressure(MBP) at various intervals.All patients showed no ventilator-induced lung injury.Arterial blood oxygenation was obviously improved in two groups after 24 hours mechanical ventilation,PCV group had better partial of oxygen in artery(PaO2) than VCV group.Conclusion:Both PCV and VCV can improve arterial blood oxygenation,prevent ventilator-induced lung injury,and have less disturbance in hemodynamic parameters.PCV with lung protective ventilatory strategy should be early used for patients with ARDS.