PRVC和P-SIMV通气模式下对慢性阻塞性肺疾病患者机械通气参数安全性的研究

Study on the safety of ventilation modes of PRVC and P-SIMV for mechanical ventilation parameters of patients with COPD

目的:研究呼吸机压力调节容量控制(PRVC)模式和压力同步间歇指令通气(P-SIMV)模式下对于慢性阻塞性肺疾病(COPD)患者机械通气参数安全性的影响,分析两种模式下参数安全的差异性。方法:选取医院收治的34例COPD I级和II级患者,将其按照所使用的通气模式分为PRVC组和P-SIMV组,每组17例。记录每例患者连续24 h内的分钟通气量上限和下限的报警记录次数,以及平均气道压上限和平均气道压下限,并比较两组相同参数报警次数的差异性。结果:PRVC组分钟通气量上限报警次数为(8.0±3.8)次,明显少于P-SIMV组分钟通气量上限报警的(11.1±4.7)次,其差异有统计学意义(t=-2.124,P<0.05);PRVC组分钟通气量下限报警次数为(10.9±3.6)次,明显多于P-SIMV组分钟通气量下限报警的(8.6±2.5)次,其差异有统计学意义(t=2.123,P<0.05);PRVC组平均气道压上限报警次数为(7.2±3.9)次,明显少于P-SIMV组平均气道压上限报警的(9.7±3.0)次,其差异有统计学意义(t=-2.083,P<0.05);PRVC组平均气道压下限报警次数与P-SIMV组比较无差异。结论:PRVC模式对COPD患者机械通气时更容易触及分钟通气量下限报警,P-SIMV模式更容易触发分钟通气量上限报警和平均气道压上限报警,而二者在平均气道压下限报警次数上无统计学差异。

Objective: To study effects of ventilator under PRVC mode and P-SIMV mode on the safety of mechanical ventilation parameter of patients with COPD, and analyze the differences of parameter safety under the two modes. Method: 34 patients with COPD I and COPD II were selected and were divided into PRVC group(17 cases) and P-SIMV group(17 cases) according to they adopted ventilation mode. The times of alarm records of upper limit of minute ventilation(MV) and lower limit of MV, and the alarm times of upper limit of average airway pressure and lower limit of average airway pressure of each patient within consecutive 24 hours were recorded. And then, the difference of alarm time of same parameter between the two groups were compared. Results: The alarm times of upper limit of MV of PRVC group(8.0±3.8 times) was significantly less than that of P-SIMV group(11.1±4.7 times)(t=-2.124, P<0.05). The alarm times of lower limit of MV of PRVC group(10.9±3.6 times) was significantly more than that of P-SIMV group(8.6±2.5 times)(t=2.123, P<0.05). The alarm times of upper limit of average airway pressure of PRVC group(7.2±3.9 times) was significantly less than that of P-SIMV group(9.7±3.0 times)(t=-2.083, P<0.05). While the difference of alarm times of lower limit of average airway pressure between PRVC group and P-SIMV group was not statistically significant. Conclusion: For patients with COPD, PRVC mode is easier to trigger the alarm of lower limit of MV, while P-SIMV mode is easier to trigger the alarm of upper limit of MV and the alarm of upper limit of average airway pressure. However, there is no statistical difference between them in the alarm times of lower limit of average airway pressure.