压力调节容量控制通气模式在心肺复苏中的临床疗效观察

An observational study of pressure regulated volume control ventilation mode in cardio-pulmonary resuscitated patients

目的观察压力调节容量控制通气(PRVC)模式在心肺复苏中的临床效果。方法选取2013年1月至2015年12月在温州医科大学附属苍南医院就诊的各种心源性原因引起心脏骤停的成年患者35例,采用PRVC模式通气(PRVC组),同时回顾分析前期研究同类患者70例,其中,采用压力控制通气(PCV)模式通气35例(PCV组),采用容量控制通气(VCV)模式通气35例(VCV组)。采用单因素方差分析3组自主循环恢复(ROSC)成功后动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、氧合指数(OI)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、气道峰压(PIP),有统计学意义组间行SNK法多重比较;ROSC例数组间比较采用χ~2检验。结果 (1)PRVC组ROSC例数高于PCV、VCV组,差异有统计学意义(χ~2=6.533,P<0.05)。(2)PRVC组的PaO_2、OI高于PCV、VCV组,差异均有统计学意义(F=19.601、31.562,P均<0.05),而CVP、PIP低于PCV、VCV组,差异均有统计学意义(F=12.045、8.340,P均<0.05),PaCO_2、HR、MAP组间比较,差异均无统计学意义(P均>0.05)。结论 PRVC模式在心肺复苏中ROSC较高,ROSC成功后对患者有较好的呼吸支持作用,能较好改善呼吸功能,对血液动力学影响小,有利于提高心肺复苏成功率。

To observe the effects of pressure regulated volume control （PRVC） ventilation mode in cardio-pulmonary resuscitated patients. Thirty-five adult patients who suffered from cardiorespiratory arrest were PRVC ventilated and so called PRVC-group. An retrospective collection of another 70 adult patients who suffered from cardiorespiratory arrest were divided into two groups according to the ventilation mode the received： PCV （pressure controlled ventilation） -group （n=35） and VCV （volume control ventilation）-group （n=35）. The arterial partial pressure of oxygen （PaO2）, arterial carbon dioxide partial pressure （PaCO2）, oxygenation index （OI）, heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP） and peak inspimtory pressure （PIP） of the patients after successful resuscitation of spontaneous circulation （ROSC） in each group were analyzed by One-Way AVOVA. The index would be further analyzed using Student-Newman-Keuls （SNK） if statistically significant. The ROSC rates in the three groups were analyzed by chi-square test. （1）The ROSC rate in PRVC-group is higher than in PCV-group or VCV-group, with statistical significance （χ2=6.533, P〈0.05）. （2）The PaO2 and OI in PRVC-group is higher than those in PCV-group and in VCV-group （F=19.601, 31.562, P〈0.05）, while the CVP and PIP in PRVC-group is lower than those in PCV-group and in VCV-group （F=12.045, 8.340, P〈0.05）, and PaCO2, HR and MAP among these three groups have no statistically significant difference. PRVC ventilation may help with a higher successful ROSC rate in cardio-pulmonary resuscitated patients due to its good ventilation support. Moreover, it can preferably improve oxygenation with little influence on hemodynamics, which also facilitate the success rate of cardio-pulmonary resuscitation.