合并有心脑血管病患者心肺复苏时机械通气中气道高压报警上限的设置分析

Analysis on alarm upper limit setting of airway high pressure during mechanical ventilation of cardio-pulmonary resuscitation in patients combined with cardio-cerebrovascular disease

目的探讨呼吸机的气道峰压水平设置对心脑血管病患者心肺复苏（CPR）中机械通气的影响。方法选择2012年6月-2015年12月在我院因心跳呼吸骤停,需行CPR的患者90例,采用随机数字表法分为小潮气量（VT）通气组（A组）和常规VT通气（B组）,每组45例。用伟康Esprit呼吸机将A组VT设置成7mL/kg,高压报警设为60cmH2O,频率10次/min;B组设置VT为10mL/kg,高压报警40cmH2O;两组患者在容量控制（VCV）模式下均选用减速波。监测记录CPR在15min、30min的动脉血气关键指标与血乳酸值,记录气道峰压在〈40cmH2O、40-49cmH2O、50-59cmH2O、≥60cmH2O中发生例数、复苏成功率、吸气峰压变化等情况。结果两组患者在一般情况、心搏骤停时间、复苏后并发症发生等情况方面比较,差异无统计学意义（P〉0.05）。在复苏成功率方面A组高于B组,差异有统计学意义（P〈0.05）。A组患者在吸气峰压变化值方面与B组比较,差异有统计学意义（P〈0.05）。心肺复苏后15min、30min动脉血气关键指标及血乳酸值变化,A组与B组比较,差异有统计学意义（P〈0.05）。结论在CPR期间机械通气使用减速波,设置初始患者气道高压报警上限时可选择60cmH2O为界值,不会产生过多报警事件影响机械通气的效果,还能提高复苏成功率。

Objective To discuss the effect of ventilator setting of peak airway pressure level on mechanical ventilation of cardio-pulmonary resuscitation （CPR） in patients combined with cardio-cerebrovascular disease. Methods 90 patients requiring CPR due to cardiopulmonary arrest treated in our hospital from June 2012 to December 2015 were selected and randomly divided into small volume of tidal（VT） ventilation group（group A） and the conventional VT ventilation group （group B）, each with 45 patients. Respironics Esprit ventilators were used. VT was set as 7ml/kg in group A, and the high pressure alarm was set as 60 cmH2O, with frequency as 10 times/min. While in group B, VT was set as 10 ml/kg, and the high pressure alarm was set as 40 cmH2O. Decelerating flow in pattern of volume control ventilation （VCV） was selected in both groups. Key indicators of arterial blood gases and blood lactic acid value were monitored and recorded at 15 rain and 30 rain of CPR. The numbers, successful rate of resuscitation, and changes of peak inspiratory pressure at〈40 cmH2O,40-49 cmH2O,50-59 cmH2O,and ≥60 cmH2O of peak airway pressure. Results There were no significant differences in general situation, time of sudden cardiac arrest, and incidence of complications after recovery between two groups（P〉0.05）. The successful rate of resuscitation was significantly higher in group A than in group B （P〈0.05）. There were significant differences in changes of peak inspiratory pressure between two groups （P〈0.05）. There were significant differences in key indicators of arterial blood gases and blood lactic acid value at 15 min and 30 min of CPR between two groups（P〈0.05）. Conclusion When using decelerating flow in mechanical ventilation during CPR, 60 cmH2O can be set as the alarm upper limit of airway high pressure, by which no overmany alarm events will influence the effect of mechanical ventilation and the successful rate of resuscitation can be improved.