机械通气时人机对抗的原因分析及防治策略

目的探讨机械通气患者发生人机对抗的原因和防治对策。方法对在机械通气过程中出现人机对抗78例患者的临床资料进行回顾性分析。结果78例发生人机对抗的机械通气患者中，其发生原因包括：气道阻塞27例，不能耐受插管16例，分钟通气量不足9例，支气管痉挛7例，持续高热4例，急性肺水肿4例，单肺通气3例，抽搐、肌肉痉挛3例，管道漏气2例，呼吸机故障2例，气胸1例。结论人机对抗的发生均有其诱发因素。气道阻塞、不能耐受插管、潮气量不足、支气管痉挛等是主要原因。加强气道管理、设置合适的通气模式和（或）参数、解除气道痉挛、祛除诱因等综合有效防治措施，可避免和减少人机对抗的发生。

Discussion on the resason remedial strategy in patients with intermittent positive pressure ventilation( IPPV) resisted to mechanical ventilation

Objective To discuss the reasons and strategy of patients with IPPV resisted to mechanical ventilation. Methods To analyze the data of patients with IPPV resisted to mechanical ventilation retrospectively. Results There were 78 cases resisted to mechanical ventilation with IPPV. The causes of resistance were multiple , including 27 cases with airway obstruction, 16 cases with intolerable intubation, 9 cases with insufficient minute volume, 7 cases with bronchial spasm, 4 cases with persistant high fever, 4 cases with acute pulmonary edema, 3 cases with single lung ventilation,3 cases with twitch or convulsion, 2 cases with leakage of tube,2 cases with breakdown of ventilator and 1 case with pneumothorax. Conclusion The causes of resistance are mainly airway obstruction,intolerable intubation, bronchial spasm, insufficient tidal volume etc. It could be avoided and reduced the ratio of patients with IPPV resisted to mechanical ventilation through enhancing airway management and setting up adequate respiratory mechanical parameter and relieving bronchial spasm.