Effects of different levels of constant flow on respiratory mechanics in respiratory failure patients during volume-assured pressure support ventilation
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF EMERGENCY MEDICINE
- Issue:
- 1
- DOI:
- 10.3760/j.issn:1671-0282.2005.01.004
- Key Word:
- 机械通气;容积保证压力支持;呼吸衰竭;肺力学
Abstract： 目的探讨在容积保证压力支持(VAPS)通气时不同水平的恒定供气流量(CF)对呼吸衰竭患者肺力学参数的影响.方法呼吸衰竭患者14例,其中男性11例,女性3例,年龄(67±2)岁.基础疾病为慢性阻塞性肺疾病(COPD)8例,急性肺损伤(ALI)6例,所有患者均接受气管插管及机械通气支持24h以上.保持患者处于镇静状态,首先应用定容型通气模式(VCV),潮气量(VT)7～9 ml/kg;随后转为VAPS通气,吸气压(Pinspl)等于VCV时的Pplat,CF分别为15L/min和10L/min,最后予以压力支持通气(PSV).COPD呼吸衰竭患者在沙丁胺醇600μg后重复上述各模式通气.结果与VCV相比,COPD患者在VAPS通气时的气道峰压(PSV)以及峰压与气道平台压之差(PIP-Pplat)明显降低,在VT相近的情况下,平均吸气流量(VT/TI)呈显著下降[(17.8±3.6)L/min(CF为15L/min),(13.6±2.7)L/min(CF为10L/min)与(31.3±2.9)L/min(VCV)],而与PSV时相近(均P＜0.05).吸入沙丁胺醇后,VAPS时的吸气峰流量(PIF)明显增高[(27.1±1.3)L/min与(937.1±1.9)L/min,P＜0.05)],但PIP与PIP-Pplat却进一步降低.ALI患者在VAPS时的PIF增高最为明显,CF为10 L/min时PIP-Pplat降至(1.2±0.3)cmH2O,此时CF/PIF为(23.3±1.1)%,结论VAPS是一种较新的闭环控制型机械通气技术,通过采用一次通气内双重控制原理,呼吸机可提供与患者实际吸气需求相适应的供气流量而达到减少患者呼吸作功的目的,同时保证提供准确控制的潮气量.VAPS时CF越小(≤15L/min),CF/PIF≤25%,可明显降低气道峰压.
- [1]周新,陈宇清,赵冰清.容积标限压力控制通气时吸入沙丁胺醇对呼吸衰竭患者通气参数的影响[J].2004,(5).
- [2]中华医学会呼吸病学分会.急性肺损伤/急性呼吸窘迫综合征的诊断标准（草案）[J].2000,(4).
- [3]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南[J].2002,(8).
- [4]F García Río,C Prados,E Díez Tejedor,etc.Breathing pattern and central ventilatory drive in mild and moderate generalised myasthenia gravis.[J].1994,49(7).
- [5]Marcelo Britto Passos Amato,Carmen Silvia Valente Barbas,Jorge Bonassa,etc.Volume-Assured Pressure Support Ventilation (VAPSV): A New Approach for Reducing Muscle Workload during Acute Respiratory Failure[J].1992,102(4).
- [6]M. A. E.Ramsay,T. M.Savege,B. R. J.Simpson,etc.Controlled Sedation with Alphaxalone-Alphadolone[J].1974,2(5920).
- [7]FERNANDEZ RAFAEL,MENDEZ MANUEL,YOUNES MAGDY.Effect of Ventilator Flow Rate on Respiratory Timing in Normal Humans[J].1999.
- [8]G R, Flick,P E, Bellamy,D H, Simmons.Diaphragmatic contraction during assisted mechanical ventilation.[J].1989,96(1).