不同流速模式同步间歇指令通气和压力调节容量控制通气的呼吸力学与能量代谢

Clinical study on respiratory dynamics and energy expenditure between synchronized intermittent mandatory ventilation (SIMV) with different inspiratory flow modes and pressure regulatedvolume control ventilation (PRVC)

目的 比较恒速与减速同步间歇指令通气(SIMV)和压力调节容量控制(PRVC)3种呼吸模式在呼吸力学和能量代谢方面的异同。方法选取28例房、室间隔缺损修补术后患者,分别采用2种不同流速模式的SIMV(恒速和减速)和PRVC模式进行机械通气,观察气道峰压、气道阻力、心率、血压、中心静脉压、氧耗、能量代谢以及血气分析等指标的变化。结果 恒速SIMV模式的气道峰压、气道阻力、氧耗与能量代谢均明显高于减速SIMV与PRVC模式(P<0.01);而减速SIMV与PRVC模式间的上述指标无显著差异(P>0.05);3种模式间其他指标无显著性差异(P>0.05)。结论减速SIMV与PRVC模式可以有效地降低气道压力、气道阻力,还可以明显降低机械通气期间的氧耗与能量消耗,有利于疾病的康复。

Objective To compare the differences in respiratory dynamics and energy expenditure between SIMV of constant and decelerating flow modes and PRVC. Methods 28 ventricular septal defect (VSD) and atrial septal defect (ASD) patients recruited in the study were ventilated postoperatively by different ventilation modes, i.e. SIMV of constant and decelerating flow modes and PRVC. The Peak inspiratory pressure (PIP), airway resistance (Raw), systolic blood pressure (SBP), di-astolic blood pressure (DBP), central venous pressure (CVP), CO2 production (VCO2), O2 consumption (VO2 ), respiratory quotient (RQ), energy expenditure (EE) and blood gas analysis parameters were noticed. Results The values of PIP, Raw, VCO2 , VO2, RQ and EE under SIMV with constant flow were significantly higher than those under SIMV with decelerating flow and under PRVC( P < 0.001). There were no significant differences in PIP, Raw, VCO2, VO2 , RQ and EE between SIMV with decelerating flow and PRVC( P > 0.05). Conclusion SIMV with decelerating flow and PRVC produce lower airway pressure and airway resistance, cause less O2 consumption and energy expenditure, as compared with SIMV with const flow.