体外循环心脏手术后患者应用PRVC和 VC模式的临床比较

目的比较压力调节容量控制通气(PRVC,pressureregulatedvolumecontrol)和容量控制通气(VCV,volumecontrolventilation)在体外循环心脏手术后患者应用的效果。方法30例体外循环心脏手术后患者先后予以VC模式及PRVC模式、VC模式通气各30分钟,更改模式时呼吸机设置参数不变,观察两种模式机械通气时的吸气峰压(PIP)、平均气道压(Pmean)、血流动力学参数和血气分析指标。结果PRVC模式和VC模式比较PIP更低,(P<0.05),差异有显著性意义。血流动力学参数、血气分析指标比较(P>0.05),差异无显著性意义。结论PRVC模式结合了定压和定容模式的优点,降低了PIP过高导致气压伤的风险,可安全应用于体外循环患者。

Pressure- regulated volume control vs. volume control ventilation in patients undergoing extracorporeal circulation surgery

Objective To compare how the two models of positive ventilation affect airway pressures, hemodynamic parameters, arterial blood gas in patients undergoing extracorporeal circulation surgery. Methods Thirty patients were enrolled immediately after surgery for heart disease and stabilized on a Siemen's servo 300 ventilator in volume control model (VCV1) in the intensive care unit. Tidal volume was set at l0 ml/kg. Hemodynamic parameters, airway pressures and ventilator settings, and arterial blood gas were measured. Patients were then changed to pressure-regulated volume control model (PRVC) with the tidal volume set as before. Measurements were repeated after 30 minutes. Patients were then returned to volume control mode (VCV2) and final measurement undertook after 30 minutes. Results Peak inspiratory pressure was significantly lower as using PRVC than VC (cmH_2O vs. cmH_2O, P<0.05). No other statistically significant differences were found. Conclusion Mechanical ventilator using a pressure-regulated volume control model will decrease peak inspiratory pressure without affecting hemodynamics and arterial blood gas. It can be safely used in extracorporeal circulation surgery.