不同潮气量机械通气在肺不张病人中应用的对比研究

Comparison of the clinical value of different tidal volumes in the patients with atelectasis during continuous positive pressure mechanical ventilation

目的对比研究较大潮气量(BVT)、常规潮气量(CVT)和较小潮气量(SVT)持续正压机械通气在肺不张病人中的临床应用价值。方法对20例肺不张病人先后给予SVT、CVT和BVT机械通气,记录并比较三种不同潮气量机械通气30min后的气道峰压(Ppeak)、气道平均压(Pmean)、静态肺顺应性(Cst)、气道阻力(Raw)的大小,同时比较三种不同潮气量机械通气对平均动脉压(MBP)、中心静脉压(CVP)及氧合指数(PaO2/FiO2)、pH值、二氧化碳分压(PaCO2)的影响。结果Ppeak、Pmean、CVP、pH值随着潮气量的增加而增加(P<005);BVT组的PaO2/FIO2及Cst值显著低于CVT组和SVT(P<005);PaCO2值随着潮气量的增加而减少(P<005);三组病人的Raw、NBP值无显著性差异(P>005)。结论对持续正压机械通气的肺不张病人,SVT在改善呼吸力学、血流动力学及氧合方面优于CVT和BVT。

Objective To compare the clinical value of bigger tidal volume (BVT),conventional tidal volume(CVT)and smaller tidal volume(SVT)in patients with atelectasis during continuous positive pressure mechanical ventilation.Mothods Twenty patients with atelectasis were included in this study.Patients accepted continuous positive pressure mechanical ventilation with SVT,CVT and BVT in order. Respiratory mechanics,hemodynamics and arterial blood gas at 30 min after continuous positive pressure mechanical ventilation with each tidal volume were recorded and compared.Results Ppeak, Pmean,CVP,pH increased following the addition of the tidal volume. Oxygenation index (PaO_2/FiO_2)and PaCO_2 were obviously higher in SVT than in CVT(P<0.05) and BVT (P<0.05) and were higher in CVT group than in BVT group (P<0.05).The static respiratory system compliance(Cst)was significantly lower in SVT and CVT than in BVT (P<0.05),but there was no statistical difference in the SVT and CVT (P>0.05).Three kinds of tidal volume had no significant difference in the airway resistance(Raw)and mean arterial blood pressure(MAP)(P>0.05).Conclusions In the patients with atelectasis during continuous positive pressure mechanical ventilation,SVT have the more advantage of improving respiratory mechanics,hemodynamics and arterial blood gas over CVT and BVT. [