压力控制通气在体外循环术后的应用探讨

TREASURE CONTROLLED VENTILATION IN TREATMENT OF POST CARDIOTOMY PATIENTS WITH CARDIOPULMONARY BYPASS

目的探讨压力控制通气模式在体外循环术后患者的临床应用价值。方法比较体外循环术后患者压力控制通气(PCV)组和容量控制通气(VCV)组治疗前、治疗后2h和6h气道峰压、平均气道压的大小,同时比较两种模式对血气分析、血液动力学指标的影响。结果PCV组治疗后2h和6h PIP、MPaw均显著低于VCV组(P<0.01)。PCV组较VCV组治疗后血气分析、血流动力学改善明显,与VCV组相比,血氧分压、心脏指数、肺动脉楔压和中心静脉压有显著差异(P<0.01,P<0.05)。结论PCV模式对体外循环术后呼吸支持较VCV模式更能显著降低气道峰压,平均气道压,改善血气指标,有利于术后患者血流动力学的恢复。

Objective To study the therapeutic effects of pressure controlled ventilation on post car-diotomy patients with cardiopulmonary bypass. Methods 40 post cardiotomy patients with cardiopul-monary bypass were included in the study. The patients received mechanical ventilation immediately after admission and were randomly divided into two groups:pressure controlled ventilation( PCV) group (n = 20) and volume controlled ventilation(VCV) group(w =20).The data of the peak airway pres - sure (PIP) ,the mean airway pressure (MPaw) ,and the blood gas analysis at the beginning of the ventilation,2 hour(PTh2) and 6 hour(PTh6) after treatment in the two groups were recorded and compared. Parameters of the hemodynamics at the beginning and 6 hour (PTh6) after were recorded and compared. Results PIP in PCV group at PTh2 and PTh6 were (18.22 ± 0.44)mmHg and ( 14. 78 ±0.48)mmHg respectively,and were significantly lower than those in VCV group (both P<0.01). The MPaw in PCV group at PTh2 and PTh6 were (7.58± 0.41)mmHg and (4.65 ± 0. 72)mmHg respectively, and showed significant difference in those of VCV group (both P<0. 01). The blood gas analysis in PCV group at PTh2 and PTh6 were obviously higher than those in VCV group (both P < 0.01).The cardiac index(CI) .pulmonary capillary wedge pressure (PAWP) and central venous pres-sure(CVP) in PCV group at PTh6 were (3. 11 ± 0. 08)L/(min-m2), (14. 40 ± 0. 53)mmHg and (9.08±0. 42)mmHg,had significant difference with those in the VCV group(P<0. 01 and P< 0.05). Conclusion PCV can significantly lower the PIP and MPaw level and improve the lung and myocardial function than VCV in the treatment of post cardiotomy patients following cardiopulmonary bypass.