摘要
目的观察双水平气道正压(BIPAP)、压力支持(PSV)、成比例压力支持通气(PPS)3种不同通气模式对心功能正常及心功能低下患者血流动力学的影响,探讨心功能严重低下、撤机困难患者较理想的撤机方式。方法70例各种原因导致呼吸衰竭而行机械通气的患者根据撤机模式不同分为PSV组(38例)和PPS组(32例)。PPS组经治疗恢复自主呼吸后,行无创血流动力学监测,根据心排血指数(CI)将患者分为心功能正常组(CI≥2.0L·min-1·m-2)和心功能低下组(CI<2.0L·min-1·m-2),比较两组患者在BIPAP、PSV、PPS3种通气模式对血流动力学的的影响。结果1心功能正常组PSV、PPS通气模式下心排血量(CO)、CI、每搏量(SV)、肺毛细血管血流(PCBF)均显著高于BIPAP模式,PPS模式下CO、CI、SV、PCBF最高,但与PSV模式下比较差异无显著性;PPS模式下外周血管阻力(SVR)较BIPAP模式显著降低,但较PSV模式差异无显著性。2心功能低下组BIPAP、PSV、PPS通气模式下CO、CI、SV逐渐升高,3种通气模式间差异有显著性,PPS模式下CO、CI、SV最高。3心功能低下患者3种通气模式下气道峰压(Ppeak)、平均气道压(Pmean)均呈递减趋势,PSV、PPS模式下与BIPAP模式差异有显著性,PPS模式下心功能低下组Ppeak最低,与另两种模式比较差异有显著性。4PPS组带机时间较PSV组明显缩短。5心功能正常组3种模式的内源性呼气末正压(PEEPi)也呈递减趋势,PPS为最低,与BIPAP模式比较差异有显著性(P<0.01)。结论PPS通气模式对心功能严重低下的机械通气患者血流动力学影响最小,较适用于作为该类患者的撤机模式。
Objective To observe the effect on mechanical ventilation with biphasic positive airway pressure （BIPAP）, pressure support ventilation （PSV）and proportional pressure support （PPS） modes on hemodynamics in patients with either normal cardiac function or impaired cardiac function in order to optimize the time to wean mechanical ventilation in patients with severe cardiac dysfunction. Methods Non-invasive cardiac output （NICO） monitoring was instituted in patients 32 with respiratory failure due to different causes, when spontaneous respiration was restored, and they were separated into two groups depending on whether the cardiac index （CI） was normal （CI≥2.0 L·min^-1·m^-2） or not （CI〈2.0 L·min^-1·m^-2）. The effects of BIPAP, PSV and PPS modes on changes in hemodynamics were compared between two groups. Results ① In patients with normal cardiac function, CO, CI, stroke volume （SV）, pulmonary capillary blood flow （PCBF） were significant higher in PSV and PPS modes than BIPAP mode, and they were highest with PPS mode, but no significant difference compared with PSV. Surround vascular resistance （SVR） was reduced significantly in PPS mode compared with BIPAP, but no significant difference was found compared with PSV. ② In patients with cardiac dysfunction, CO, CI increased gradually when ventilated in BIPAP, PSV, PPS modes and significant difference was found among three groups. In PPS mode, CO and CI were highest. ③The trends of peak airway pressure （Ppeak） and mean airway pressure （Pmean） were degressive in three groups. In both normal cardiac function group and cardiac dysfunction group, significant difference was found in PSV and PPS modes compared with BIPAP. Ppeak was lowest in PPS mode in cardiac dysfunction group, and there was significant difference compared with the other groups. ④ The ventilated time was significant reduced in PPS mode compared with PSV. ⑤In normal cardiac function group, instinct positive end expiratory pressure （PEEPi） showed degressive trend among three different modes, and it was lowest in PPS mode, with significant difference compared with the other two groups. Conchsion In PPS mode, the effect to hemodynamics in patients with severe cardiac dysfunction is minimal, so it is suitable as a weaning mode in this gruops of patients.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2006年第6期363-366,共4页
Chinese Critical Care Medicine
基金
天津市自然科学基金资助项目(023612211)
关键词
比例压力支持
血流动力学
心功能
机械通气
撤机
proportional pressure support
hemodynamics
cardiac function
mechanical ventilation
weaning
