高频程序通气对心肺复苏呼吸支持作用的临床观察

Clinical observation on the effect of high frequency procedure control ventilation on cardiopulmonary resuscitation

目的探讨高频程序控制通气在心肺复苏过程中的应用价值。方法30例心肺复苏术后无自主呼吸的患者随机分为3组：常规控制通气组（A组）、5：5高频程序控制通气组（B组）及7：3高频程序控制通气组（C组），各组分别采用相应的机械通气模式进行呼吸支持。自主循环恢复开始计时，分别测定0、1、4、12、24h动脉血氧分压（PaO2）、氧合指数（0I）、动脉二氧化碳分压（PaCO2）、心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、气道峰压（PIP）。结果①B、c组Pa02、OI在1、4、12h均显著高于A组（P〈0．01）；C组PaO2、OI在4、12、24h均高于B组（P〈0．05）。PaCO2各时点组间比较差异无统计学意义（P〉0．05）。②各时点B、C组PIP、CVP均低于A组（P〈0．01），B、C组MAP均高于A组（P〈0．05），三组HR比较差异无统计学意义（P〉0．05）。结论高频程序控制通气对心肺复苏患者具有较好的呼吸支持作用，改善氧合快，对血流动力学影响小，不易产生二氧化碳潴留，使用便捷。两种程序控制通气中，高频与常频通气时间比为7：3的高频程序控制通气模式通气效果更佳。

Objective To explore the clinical value of high frequency procedure control ventilation during cardiopulmonary resuscitation. Methods 30 patients without spontaneous respiration during cardiopulmonary resuscitation were randomly divided into three groups： conventional control ventilation group （ group A） ,5：5 high frequency procedure control ventilation group （ group B） and 7：3 high frequency procedure control ventilation group （ group C ） . Every group used corresponding mechanical ventilation mode to support the respiration. At the beginning of spontaneous circulation restoration, PaO2, OI, PaCO2 , HR, MAP, CVP, PIP at O, 1,4, 12 and 24 h were measured. Results ①PaO2 and OI were significantly higher in group B and group C than in group A at 1,4 and 12 h （P 〈0.01 ） ; PaO2 and OI were significantly higher in group C than in group B at 4, 12 and 24 h （P 〈0. 05）. PaCO2 had no any significant between - group differences at any time points （ P 〉 O. 05 ）. ②CVP, PIP were lower in group B and group C than in group A at any time points （ P 〈0.01 ） ; MAP were higher in group B and group C than in group A at any time points （P 〈 0.05） , HR in three groups had no any significant between - group differences at any time points （ P 〉 O. 05 ）. Conclusion High frequency procedure control ventilation plays an important role in respiratory support during cardiopulmonary resuscitation. It could improve oxygenation quickly, lessen the effect on hemodynamic, not easy to generate CO2 retention, and used conveniently. In two kinds of high frequency procedure control ventilation, curative effect of 7：3 group are the best during cardiopulmonary resuscitation.