压力和容量控制通气在机械通气患者纤维支气管镜操作中的临床观察

Clinical Observation of Pressure and Volume Control Ventilation in Operation of Fiberoptic Bronchoscopy in Patients Using Mechanical Ventilation

目的:探讨压力控制通气(PCV)和容量控制通气(VCV)在机械通气患者纤维支气管镜操作中的临床效果。方法:将2015年5月至2016年9月收治的机械通气中行纤维支气管镜操作的60例患者随机分为PCV组(n=30)和VCV组(n=30),比较操作前及操作中心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、外周氧饱和度(SaO_2)、动脉血氧分压(PaO_2)、气道平台压(Pplat)、气道峰压(Ppeak)、呼气末正压(PEEP)、潮气量(Vt)、肺顺应性(Cdyn)的变化。结果:操作前、后两组患者HR、RR、Ppeak、Pplat、Cdyn及MAP均有明显差异(P<0.05),VCV组操作中Ppeak与操作前对比有明显差异(P<0.05),而PCV组Ppeak操作中与操作前比较无明显差异(P>0.05)。结论:对机械通气患者行纤维支气管镜操作时应用PCV模式对患者肺顺应性影响小,可降低气道峰压和平台压,避免患者生命体征明显波动。

Objective ： To explore the clinical effect of pressure control ventilation （ PCV ） and volume control venti- lation （VCV） in the operation of fiberoptic bronchoscopy in patients using mechanical ventilation. Methods： 60 eases received fiberoptie bronchoscopy in mechanical ventilation from May 2015 to Septr 2016 were randomly divided into PCV group （ n=30 ） and VCV group （n=30）. The heart rate （ HR ） , respiration rate （ RR ） , mean artery pressure （ MAP ） , peripheral oxygen saturation （ SaO2 ） , arterial oxygen partial pressure （ PaO2 ） , airway platform pressure （ Pplat ） , airway peak pressure （ Ppeak ） , expiratory end pressure （PEEP） , tidal volume （Vt） and the lung compliance were compared before and after the fiberoptic bronchoscopy between the two groups. Results： The HR, RR, Ppeak, Pplat, Cdyn and MAP of the two groups were significantly different before and after the operation （P〈0.05）. The Ppeak was a statistical difference between pre-operation and operation in VCV group （P〈0.05） , while there was no difference in PCV group （P〉0.05）. Conclusion： The application of PCV model in the operation of fiberoptie bronehoscopy in patients using mechanical ventilation has little effect on the lung compliance, which can reduce the pressure of the airway peak and the pressure of the platform, so as to avoid the severe fluctuation of the patient＇s vital signs.