吸气峰压、平台压对机械通气下呼吸窘迫鉴别的意义

Diagnosis significance of peak airway pressure and plateau pressure in the respiratory distress with mechanical ventilation

目的探讨机械通气下峰压和平台压对呼吸窘迫鉴别诊断的意义。方法对60例机械通气下出现呼吸窘迫的患者进行分析,记录吸气峰压(PAP)和平台压(Pplateau)参数的变化情况,同时记录吸气峰压升高组系统静态顺应性(Cst)、气道阻力(Raw)的变化,并对病因进行分析。结果呼吸窘迫时,吸气峰压可出现增加,减少,和不变,峰压增加包括平台压增加(包括肺水肿、肺不张、气胸等)和不变(气道痉挛、分泌物增多和误吸等),吸气峰压的增加主要见于Raw增加(平台压不变)和Cst的下降(平台压增加),吸气峰压的减少见于通气环路漏气和过度通气,而吸气峰压不变见于肺栓塞和贫血。结论吸气峰压和平台压的变化,对机械通气下的呼吸窘迫的病因有一定的鉴别诊断意义。

Objective To explore the diagnosis significance of peak airway pressure and plateau pressure in the respiratory distress with mechanical ventilation. Method The peak airway pressure （PAP）,plateau pressure,and the chest static state compliance（Cst） and airway resistance （Raw） were recorded for 60 patients with respiratory distress in mechanical ventilation,and the pathogenesis were also analyzed. Results It was found that the patients with plateau pressure increasing （including abdominal distention,pneumothorax,pulmonary atelectasis,et al）,the other was not（including airway obstruction,airway spasm,airway secretion increasing）. The patients with higher plateau pressures always had lower Cst,but the higher PAP without higher plateau pressures usually had higher Raw,PAP decreasing include the respiratory circulation leaking and ventilation excessive. Pulmonary embolism and anemia were found no change in the PAP. Conclusion PAP and plateau pressure may be clinical indicator for diagnosis of respiratory distress with mechanical ventilation.