压力调节容量控制与容量控制用于急性有机磷农药中毒治疗

目的通过对照比较压力调节容量控制(PRVC)通气模式与容量控制(VC)通气模式在急性有机磷农药中毒(AOPP)患者呼吸及循环功能的影响,为临床呼吸机应用提供参考。方法 24例急性有机磷农药中毒致严重急性呼吸衰竭患者机械通气治疗中采用自身对照方法观察PRVC与VC两种通气模式对呼吸力学指标吸气峰压(PIP)、气道平均压及指指脉氧饱和度、循环等指标的影响。除PRVC与VC模式不同外,其余呼吸机参数设置均相同。结果 PRVC组PIP值显著低于VC组[(22.4±1.1)cmH2O比(26.0±1.0)cmH2O,t=17.245,P<0.05],而两组间气道平均压值、指脉氧饱和度、循环功能各指标比较差异无统计学意义(P>0.05)。结论 PRVC应用于急性有机磷农药中毒患者机械通气治疗时较VC模式可明显降低PIP,有效防止肺气压伤,是一种保护性的通气模式。

Objective To observe the effect of pressure-regulated volume control （PRVC） ventilation on respiratory and circulatory functions of acute organophosphorus pesticide poisoning （AOPP） patients with acute respiratory failure in comparison with volume control ventilation （VC）, thus provide reference for clinical application. Methods The effect of the two ventilation modes on respiratory mechanical markers including peak inspiratory pressure （PIP）, mean air way pressure （mean AP） and circulatory index and finger pulse oxygen saturation （SpO2） parameters were observed and recorded by self-comparison when mechanical ventilation treatment were applied in 24 patients with AOPP. The parameters of ventilator setting were comparable except for PRVC and VC ventilation modes. Results PIP values in PRVC group were significantly lower than those in VC group[（22.4±1.1）cm H20 vs （26.0±1.0）cm H20, t=-17.245, P〈0.05]. There was no significant difference in Mean AP, circulatory function indexes and SpO2 parameters of two groups （P〉0.05）. Conclusion PRVC mode can be applied for AOPP patients with severe ARF during positive pressure mechanical ventilation and significantly decrease PIP. So it plays a beneficial role in preventing lung barotraumas and is one of lung protective ventilation modes.