摘要
目的:比较压力支持通气(PSV)与同步间歇指令通气压力支持水平(SIMVPS)两种机械通气方式的脱机效果。方法:对照观察两种通气方式患者在脱机时间、PS、潮气量(VT)、呼吸频率(f)、气道闭合压(P0.1)以及脱机步骤方面的差异。结果:PSV脱机成功25例,SIMVPS脱机成功13例。两种脱机方式的脱机时间、PS水平、VT、f和P0.1比较均无显著性差异(P均>0.05)。PSV脱机:短期带机(<7日)的PS应≤0.69kPa(1kPa=10.20cmH2O);长期带机(>7日)的PS应达0.49~0.59kPa,并应动态观察P0.1通气、氧合变化可成功实现脱机。SIMVPS脱机:短期带机(<7日)的PS应置于0.59~0.69kPa,SIMV的f可逐渐减至6次/min;长期带机(>7日)SIMV的f减至4次/min,并根据患者的耐受情况,同时调整PS达0.49kPa,结合常规参数变化及P0.1的变化可完成脱机过程。结论:SIMVPS脱机优于PSV脱机,尤其对不能耐受PSV脱机患者采用SIMVPS方式可成功实现脱机。SIMVPS是一种较佳的脱机方式。
Objective:To compare two weaning modes in patients with pressure support ventilation (PSV) and synchronized intermittent mandatory ventilation(SIMV)pressure support level (PS).Methods:There were 2 groups in this study:PSV successful weaning group (n=25) and SIMVPS successful weaning group (n=13).During mechanical ventilation (MV),weaning duration,PS,tidal volume (VT),respiratory frequency (f),airway occlusion pressure (P01) as well as weaning steps were compared between the two weaning modes.Results:Weaning duration,PS,VT,f and P01 showed no significant differences between the two weaning modes (all P>005).When PSV was used for weaning mode,PS level was less than 069 kPa(1 kPa=1020 cmH2O) in patients with short time of MV (<7 days),and was at 049~059 kPa in patients with long time of MV (>7 days),and dynamic changes in P01 and ventilationoxygenation were considerd.When SIMVPS was used for weaning mode,PS level was at 059~069 kPa in patients with short time of MV (<7 days) and its rate of SIMV was progressively decreased (6 cycles per minute),but when the rate of SIMV was progressively decreased (4 cycles per minute) in patients with long time of MV (>7 days),and PS level was lower than 049 kPa according to patient′s tolerance.The conventional parameters combined with the changes in P01 could serve as satisfactory guides for weaning processes.Conclusions:Weaning of SIMVPS modality is better than that of PSV alone,particularly in patients without tolerance of PSV modality.Therefore,SIMVPS mode is one of the best ventilated modalities used for weaning.
出处
《中国危重病急救医学》
CSCD
1998年第2期83-85,共3页
Chinese Critical Care Medicine
基金
天津市卫生局科研课题
关键词
压力支持通气
SIMV-PS
机械通气
pressure support ventilation\ \ synchronized intermittent mandatory ventilation\ \ continuous positive airway pressure ventilation\ \ intermittent positive pressure ventilation