摘要
目的比较在压力控制通气(PCV)与容量控制通气(VCV)模式下吸痰对慢性阻塞性肺疾病(COPD)和脓毒症患者气体交换和呼吸力学的影响。方法采取交叉对照的方法,在PCV和VCV模式下分别对96例患者进行开放式吸痰,分为COPD组(A组,n=59)和严重脓毒症组(B组,n=37),比较吸痰前后不同时间点气体交换、呼吸力学及血流动力学等指标的变化。结果在PCV模式下,A组患者吸痰后1 min、10 min时潮气量和顺应性较基线水平下降,与B组比较差异均有统计学意义(P均<0.05)。在VCV模式下,A组患者吸痰后1 min及10 min时气道峰压较基线水平增加,顺应性降低,与B组比较差异均有统计学意义(P均<0.05)。在PCV模式下,A组患者吸痰后3 min、10 min时PaO2与吸痰前比较增加,增加的比例均低于VCV模式(P<0.05);B组患者吸痰后3 min、10 min时PaO2与吸痰前比较增加,增加的比例均低于VCV模式(P<0.05)。结论吸痰在PCV和VCV模式下均引起患者呼吸力学改变,但对脓毒症致呼吸衰竭患者的影响比COPD患者更明显,吸痰对气体交换功能的影响在VCV模式下恢复的相对较快。
Objective To evaluate the effects of open endotracheal suction in the mode of pressure-controlled ventilation （PCV） and volume-controlled ventilation （VCV） on gas exchange and respiratory mechanics in acute respiratory failure （ARF） patients with chronic obstructive pulmonary disease （COPD） or severe sepsis.Methods A retrospective,crossover contrrolled cohort study was conducted in a total of 96 patients with ARF,including 59 patients with COPD （group A） and 37 patients with severe sepsis （group B）.All the patients received open endotracheal suction.in the mode of either PCV or VCV.Variations on gas exchange,respiratory mechanics and hemodynamics before and after suction were measured and compared.Results During PCV,tidal volume and compliance were decreased compared with the baseline level for patients in group A at 1 min and 10 min after suction,and there was significant difference compared with group B （all P ＜0.05）.In the mode of VCV,peak airway pressure was increased and compliance was decreased compared with baseline levels for patients in group A at 1 min and 10 min after suction,and there was significant difference compared with group B （all P ＜ 0.05）.In the mode of PCV,PaO2 was increased compared with the baseline level for patients both in group A and group B at 3 min and 10 min after suction,however,the proportion of increase was lower than that in the VCV model （P ＜ 0.05）.Conclusion Open endotracheal suction can influence respiratory mechanics of acute respiratory failure patients in both PCV and VCV mode,and the changes in patients with severe sepsis is more obvious than in patients with COPD.In the VCV,the effect on gas exchange function recoveries relatively quickly.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2013年第9期825-829,833,共6页
Journal of China Medical University
关键词
吸痰
机械通气
气体交换
呼吸力学
suction
artificial respiration
gas exchange
respiratory mechanics
