肝移植术后不同通气模式对血流动力学和氧动力学影响的差异

Influences of different mechanical ventilations on hemodynamics and oxygen kinetics in patients after liver transplantation

目的:肝移植患者术后常需短期机械通气辅助支持,对比分析不同机械通气方式对肝移植术后患者血流动力学及氧动力学指标的影响。方法:选择2006-01/12于解放军第四五八医院行背驮式肝移植的患者11例,患者对实验及治疗方案均知情同意,且得到医院伦理道德委员会批准。经漂浮导管、桡动脉导管进行持续心输出量、肺动脉压及动脉血压监测。随机交替使用容量控制通气和同步间歇指令通气加压力支持通气,观察两种通气模式下血流动力学指标及氧动力学指标的变化。结果:11例患者全部进入结果分析。同步间歇指令通气加压力支持通气模式下患者的气道停顿压明显低于容量控制通气模式(P<0.05),两组通气模式下患者其他血流动力学指标及氧动力学指标差异并无显著性意义(P>0.05)。结论:同步间歇指令通气加压力支持通气模式可作为肝移植术后患者呼吸支持和脱机过渡较为理想的通气模式。

AIM：Patients undergoing liver transplantation need short-term mechanical ventilation treatment. This article determines the outcome of mechanical ventilation on hemodynamics and oxygen kinetics in patients after liver transplantation. METHODS： Eleven patients undergoing piggyback liver transplantation were enrolled at the 458 Hospital of Chinese PLA from January to December 2006. The patients signed the informed consent. The experimental procedures were approved by the Hospital Ethical Committee. Swan-Ganz catheter and radial artery catheter were used to monitor the cardiac output, pulmonary arterial pressure, and arterial blood pressure. Pressure-regulated volume control ventilation and synchronized intermittent mandatory ventilation plus pressure support ventilation were used to support the ventilation alternately and the indexes of hemodynamics and oxygen kinetics were analyzed. RESULTS： Eleven patients were involved in the result analysis. The airway pause pressure was significantly lower under synchronized intermittent mandatory ventilation plus pressure support ventilation pattern than those under pressure-regulated volume control ventilation pattern （P 〈 0.05）. There were no differences in indexes of hemodynamics and oxygen kinetics between the two mechanical ventilation patterns （P 〉 0.05）. CONCLUSION： The synchronized intermittent mandatory ventilation plus pressure support ventilation can be a more suitable mechanical ventilation pattern for the patients after liver transplantation.