机械胸外按压时避免呼吸机误触发等问题的研究

Study on avoiding spurious triggering of ventilator during mechanical chess compression

目的研究使用心肺复苏机的过程中如何有效避免呼吸机误触发等问题。方法将83例呼吸心脏骤停患者随机分成两组,分别采用容量控制的同步间歇指令通气(V-SIMV)加压力支持水平调成0的压力支持通气(0PSV)、容量控制的辅助/控制指令通气(V-A/C)加-20cmH2O压力触发灵敏度进行通气,呼吸机高压报警初始设置均为60cmH2O,随后根据气道峰压水平进行调整。因不同患者发病时间、启动按压时间、基础疾病等差异均有统计学意义,两组生理生化指标、氧合情况、ROSC及存活率比较差异无统计学意义,未纳入统计。因抢救的紧迫性,未进行食道内压力测定。结果两组患者均未发生误触发,高压报警发生率、气道峰压水平比较差异无统计学意义[2.3%vs.2.5%,(46.74±4.12)cmH2Ovs.(47.33±3.48)cmH2O,P>0.05]。两组患者分钟通气量与理想体质量的比值(MV/kg)均高于预期目标值,且两组MV/kg比较差异有统计学意义[(152.55±6.25)mL/(kg·min)vs.(70.98±1.07)mL/(kg·min),P<0.01],但胸外按压时呼吸机所示的分钟通气量并非患者真实情况的反映。结论使用心肺复苏机进行心肺复苏时,选择V-SIMV加0 PSV或选择V-A/C加最大负值的压力触发灵敏度可避免呼吸机被误触发。提高压力报警上限并根据患者峰压水平进行调整,可减少高压报警的发生率。

Objective To use cardiopulmonary resuscitation machine for chest external pressure,such as mechanical ventilation(MV)according to normal parameters,easily trigger the ventilator to cause excessive ventilation and cause adverse consequences.The purpose of this experiment is to study how to avoid the spurious triggering of the ventilator in the process of using the cardiopulmonary resuscitation machine.Methods Eighty-three patients with respiratory cardiac arrest were nindomly divided into two groups.V-SIMV plus 0 PSV and V-A/C plus-20 cm H2O pressure trigger sensitivity were used for ventilation respectively.The initial setting of ventilator high pressure alarm was 60 cm H2O.Then adjust according to the Peak airway pressure.Due to the significant differences in the time of onset,starting pressing time,and basic diseases between different patients,the comparison of physiological and biochemical indicators,oxygenation indicators,ROSC,and survival rates between the two groups was not statistically significant and did not include statistics.Due to the urgency of rescue,no esophageal pressure was measured.Results There was no spurious triggering between the two groups,and there was no difference in the incidence of high pressure alarm and the level of peak airway pressure between the two groups [ 2.3% vs.2.5%,(46.74 ±4.12)cm H2O vs.(47.33 ± 3.48)cm H2O,P>0.05].The ratio of minute ventilation volume to ideal body weight(MV/kg)was higher than expected in the two groups,and there was a significant difference in the MV/kg comparison between the two groups[(152.55 ± 6.25)mL/(kg·min)vs.(70.98 ± 1.07)mL/(kg·min)<0.01 ].However,the MV shown on the ventilator when the chest is pressed is not a response to the patient's real situation.Conclusion When using cardiopulmonary resuscitation machine with CPR,selecting V-SIMV plus 0 PSV or selecting V-A/C plus maximum negative pressure trigger sensitivity can avoid the ventilator being spurious triggered.Raising the upper limit of the pressure alarm and adjusting it according to the patient's peak airway pressure can reduce the incidenee of high pressure alarm.