双向气道正压通气与不同流速模式同步间歇指令通气在心脏术后的比较研究

COMPARISON OF DOUBLE POSITIVE AIRWAY PRESSURE VENTILATION(DUOPAP) AND SYNCHORIZED INTERMITTENT MANDATORY VENTILIZATION(SIMV) WITH DIFFERENT INHALATION FLOW MODES IN POSTOPERATIVE CARDIAC PATIENTS

目的通过与两种不同流速模式(恒速和减速)同步间歇指令通气(SIMV)比较,评价双相气道正压通气(DuoPAP)在心脏术后应用的安全性和有效性。方法选取心内直视手术者40例,术后分别采用恒速、减速SIMV和DuoPAP模式通气,比较血流动力学、血气、呼吸力学参数及呼吸肌做功指标的变化。结果DuoPAP和减速SIMV的气道压峰值(Ppeak)、气道阻力(Raw)和吸气功(WI)较恒速型SIMV明显降低(p<0·01);前两种通气模式之间比较无统计学差异(p>0·05);三种通气模式的其他指标无统计学差异(p>0·05)。结论与传统的SIMV模式比较,DuoPAP模式对血流动力学、血气参数无明显影响,且与恒速型SIMV比较,可明显降低吸气时的Ppeak、Raw和WI,应用于心脏术后是安全、有效的。

Objective To evaluate the security and effectivity of DuoPAP in postoperative cardiac patients by comparing with SIMV in constant and decelerating inhaltion flow modes. Methods 40 patients underwent cardiac operation were selected from september 2006 to june 2007. All these patients were divided into 4 groups and underwent three kind of ventilation mode （i. e. constant SIMV, decelerating SIMV and DuoPAP） in a respective and crossed order, then compared the parameters on hemodynamics, blood gas analysis, respiratory dynamics, work of respiratory muscle. Results The values of peak inspiratory pressure （ Ppeak）, airway resistance （Raw） and work of inspiration（W/） under DuoPAP and under SIMV with decelerating flow were significantly lower than that under SIMV with constant flow（p 〈 0.01 ）. these values between the former two modes were no statistical difference（p 〉 0.05 ）. Other parameters were also no statistical difference between these three ventilation modes（p 〉 0.05 ）. Conclusion DuoPAP ventilation mode is a safe and effective mode appled in the postoperative cardiac patients, because this mode has no significant influence on hemodynamics and blood gas analysis compared with the two SIMV modes, and can lower the inspiratory Ppeak, Raw and WI significantly compared with the SIMV with constant flow mode.