压力释放通气在ards患者应用

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1、压力释放通气在ARDS通气治疗中的应用罗云鹏赵鸣雁蒋磊王浩然摘要目的评价压力释放通气对ARDS的通气、氧合、血流动力学的影响。方法ARDS患者19例，随机分为两组，APRV组（n=11）,PCV组（n=8）,两组均用PCV通气30min后取得基础值，再在APRV组通气30min、60min后分别记录两组的通气力学指标、血气指标及血流动力学指标。结果与PCV组比较，APRV组30min、60min时潮气量Vt、肺动态顺应性Cdya增加，PH、PaO2、PaO2/FiO2升高，PaCO2降低（p＜0.05），虽然平均气道压Pmean较高(P＜0.05）,但是

2、中心静脉压CVP没有多大差异（p＞0.05）,平均动脉压（ABP）、心脏指数（CI）、心率（HR）改善明显（p＜0.05）。结论ARDS的通气治疗时，当传统通气方法难以达到治疗目标的情况下应用压力释放通气是安全的、可行的，能大大改善通气和氧合，并且对血流动力学的抑制作用反而减小。关键词：压力释放通气压力控制通气急性呼吸窘迫综合征机械通气ApplicationofairwaypressurereleaseventilationainacuterespiratorydistresssyndromeZHAOMing-yanJIANGLeiLUOYun-peng

3、WANGHao-ran,IntensiveCareUnit,FirstAffiliatedHospitalofHarbinMedicalUniversity,Harbin150001,ChinaAbstract:ObjectiveToevaluatetheeffectsofairwaypressurereleaseventilationonventilation、oxygenation、hemodynamicsinacuterespiratorydistresssyndrome.MethodsNineteenpatientswithsevereARDSw

4、ereramdomizedtoreceiveAPRV(n=11)orPCV(n=8).BeforebeginningventilationwithAPRV,allpatiensintwogroupswereventilatedwithPCVfor30minutestostabilize.InAPRVgroup,Phighwas30cmH2O,Plowwas0cmH2O,Thighwas4.2s,Tlowwas0.8s;InPCVgroup,Pinspwas30cmH2O,Tinspwas1.5～3.0s,RRwas12bpm,PEEPwas8～12cmH

5、2O.VT、Pmean、CVP、HR、CI、MAPwerecontinouslymonitored,andbloodgasanalysisweremeasuredbeforeAPRV(baseline)and30min、60minafterAPRV.Sometimessedationandneuromuscularblockadewereneededtoaviodthepatient–ventilator’sfight.ResultsComparedwithPCVgroup,tidalvolumeandlungdynamiccomplianceweres

6、ignificantlyincreasedinAPRVgroup;pH、PaO2、PaO2/FiO2weremuchhigherinAPRVgroupat30minand60min.AlthoughmeanairwaypressureweredramaticallyhigherinAPRVgroup,nobigdifferenceinCVPwasfoundbetweenthetwogroups.MAP、CI、HRweresingificantlyimprovedinAPRVgroupat30minand60min.ConclusionAirwaypres

7、surereleaseventilationcanbeappliedinARDSsafelyandeffectively.Itnotonlycanimproveventilationandoxygenation,butalsohaslessinhibitiononhemodynamics.Keywordsairwaypressurereleaseventilation;pressurecontrolventilaion;acuterespiratoydistressventilation;mechanicalventilation对于ARDS的通气治疗主

8、张肺保护通气策略，相继提出了小潮气量通气、允许高碳酸血症、定压通气，大大提高了A