不同机械通气模式对急性肺损伤患者呼吸及血流动力学的影响

目的研究采用不同机械气模式对急性肺损伤（ALI）患者呼吸及血流动力学的影响。方法选择我院2010年1月~2011年12月收治的30例急性肺损伤患者,按照ALI评分分为两组,其中ALI评分值≥2.5的16例患者采用低潮气量＋呼气末正压（PEEP）通气,对14例ALI评分值〈2.5者最初采用辅助/控制通气（A/C）,逐渐改为同步间歇指令通气（SIMV）和压力支持通气（PSV）。观察机械通气过程中患者的呼吸及血流动力学的变化。结果 PEEP在5~15 cmH2O（1 cm H2O=0.098 kPa）范围内,动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）、肺静态顺应性（Cst）随着PEEP的增高而逐渐增加（P〈0.05）。在PEEP增加到20 cm H2O时心输出量（CO）和Cst下降,外周循环阻力（SVR）、肺循环阻力（PVR）和气道峰值压（PIP）增加（P〈0.05）。SIMV,PSV与A/C相比可明显降低气道峰值压（PIP）并使Cst增加（P〈0.05）。SIMV和PSV方式均可降低SVR。结论对急性肺损伤患者,应根据不同时期选择不同的机械通气模式,才能更好的增加氧供,减少对患者的呼吸和血流动力学的影响。

Effects of different ventilation mode on hemodynamics and pneumodynamics in patients with acute lung injury

Objective To research the effects of different ventilation mode on pneumodynamics and hemodynamics in patients with acute lung injury(ALI).Methods 30 cases of patients with ALI in our hospital from January 2010 to December 2011 were chosed,and were divided into two groups according to ALI score,a total of 16 patients with ALI score≥2.5 were ventilated with low tidal and positive end expiratory pressure(PEEP).14 cases of patients with ALI score<2.5 were ventilated with A/C,synchronized intermittent mandatory ventilation(SIMV) and pressure support ventilation(PSV).The hemodynamics and pneumodynamics of the two groups were obtained.Results When the levels of PEEP were during 5 to 15 cm H2O(1 cm H2O=0.098 kPa),the partial pressure of oxygen in artery(PaO2),PaO2/FiO2 and the compliance static(Cst) increased gradually(P < 0.05).The cardiac output(CO) and Cst decreased significantly when the PEEP was 20 cm H2O,at the same time,the pulmonary vascular resistance(PVR) and the systemic vascular resistance(SVR) increased(P < 0.05).Compared with A/C model,the peak inflating pressure(PIP) decreased under the PSV and SIMV,but Cst increased.Compared with the A/C model,SVR decreased significantly under the SIMV and PSV models.Conclusion Different ventilation model can be chosen for the patients with ALI according the different time,it can better increase oxygen,reduce the effects on hemodynamics and pneumodynamics in patients with acute lung injury.