双相正压通气模式和周期性同步强制式通气模式在冠状动脉旁路移植术后的应用比较

Comparison of biphasic positive airway pressure ventilation and synchronized int ermittent mandatory ventilation in postoperative coronary bypass patients

目的 比较在冠状动脉旁路移植术 (CABG)后应用双相正压气道通气 (BiPAP)模式和周期性同步强制式通气 (S IMV)模式对血流动力学和呼吸氧合参数的影响。方法 2 6例术前无其他合并症及手术顺利的CABG患者随机均分为先实施BiPAP模式组和先实施S IMV模式组 ,在术后早期镇静未醒情况下 ,分别在原有呼吸模式和改换相应呼吸模式的 1h后 ,以及再次更换回原有呼吸模式 1h后 ,监测血流动力学、血气分析及其他呼吸参数。结果 两组患者中 ,用BiPAP模式时气道吸气峰压均明显低于用S IMV模式 (P <0 .0 5 ) ,但血流动力学、血气分析及其他呼吸参数的差异无显著性。结论 与S IMV模式相比 ,BiPAP模式可显著降低气道吸气峰压 ,对血流动力学和血气无影响 ,这种模式在CABG术后应用是安全的。

Objective To compare the ventilatory and hemodynamic effects of bip hasic positive airway pressure (BiPAP) ventilation with synchronized intermitten t mandatory ventilation (S-IMV) in sedated patients after coronary artery bypas s grafting (CABG). Methods 26 patients without evidence of preoperative respirat ory dysfunction and an uncomplicated intraoperative course were investigated. Th e patients were randomly assigned to one of the two groups starting either with BiPAP or S-IMV mode. Hemodynamic measurements and blood gas analysis were perfo r med during sedation with 2.0 mg·kg -1·h -1 propofol in the primary mode, after wards switching to the alternative ventilatory mode, and again to the primary mo de. Results Inspiratory peak pressure decreased significantly during BiPAP in p atients of both groups (P <0.05). Hemodynamic parameters, blood-gas analysi s and other ventilatory parameters did not vary with the ventilatory mode. Conclusion BiPAP ventilation has no significant differentiating effects on hemodynamics a nd pulmonary gas exchange compared with S-IMV when used for ventilatory suppor t in patients after CABG and thus it is safe and reliable.