镇静治疗对机械通气患者呼吸动力学影响的评价

目的:通过微量泵输注异丙酚及咪唑地西泮镇静应用于重症监护室(ICU)有创机械通气患者,观察不同镇静程度对患者不断变化的呼吸动力学指标:平均气道峰压:(Ppeak),平均气道压力(Pmean),肺有效动态顺应性(Cdyn)肺阻力(RL),探讨镇静治疗对危重症需有创机械保护性肺通气治疗的相关性。方法:选择21例重症监护室(ICU)有创机械通气患者,采用微量泵输注异丙酚加咪唑地西泮镇静,根据SAS评分系统分兴奋激惹状态、平静合作、镇静状态与深度镇静(包括不能唤醒)四种镇静状态,每个状态记录20 min,每5 min记录一次呼吸机实际监测的呼吸动力学指标。结果:21例患者均能完成实验的全过程,试验过程中呼吸动力学监测的数据通过分析,随着镇静程度加深即兴奋级、平静和合作、镇静状态及与深度镇静(包括不能唤醒),其中各镇静级别4组呼吸动力学指标比较差异均有统计学意义(P<0.05)。结论:随着镇静水平的提高,患者肺动态顺应性和平均气道压均显著下降,但气道峰压、肺阻力无明显改善,达镇静状态后,其两者均无正态线性关系,显非线性关系。

Influence evaluation of sedative therapy to respiratory dynamics of patients with mechanical ventilation

Objective To investigate the correlation of sedative therapy on critically ill patients who required invasive mechanical lung protective ventilation treatment through infusing the propofol and midazolam sedation by micro pump infusion to the patients with mechanical ventilation in intensive care unit(ICU),and the changing respiratory dynamics [1] indicators with different degree of sedation:the average peak airway pressure:(Ppeak),mean airway pressure(Pmean),pulmonary effective dynamic adaptation(Cdyn) of lung resistance(RL).Method 21 patients of ICU(ICU) in patients with mechanical ventilation were selected,and infused propofol and midazolam by using micro pump for sedation,according to the SAS scoring system,we could part them as 4 sedative state,excited state,peaceful cooperation,sedation and deep sedation(including can′t wake).Of each state,we recorded 20 minutes,every 5minutes we recorded the actual monitoring of respiratory mechanics index of ventilator.Results 21 cases of hospitalized patients,12 cases of male,9 cases of female,were able to complete the experiment of the entire process,during experiment,we got the respiratory monitoring data,and through the analysis,with the level of sedation deepening,the respiratory dynamics index of these 4 groups:excited state,peaceful cooperation,sedation and deep sedation(including not awaken),showed significant difference(P<0.05).Conclusion With increasing of the sedation level,pulmonary dynamic compliance and mean airway pressure of patients were decreased significantly,but the peak airway pressure,lung resistance had no significant improvement,and when got sedation,the two were not normal linear relationship,they were significant nonlinear relationship.