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目的探讨机械通气时的人机对抗,即自主呼吸与机械通气不协调发生的具体原因,采取相应的防治对策。方法回顾性分析2007年11月-2010年8月安徽省蚌埠市第二人民医院重症医学科收治的60例建立人工气道,进行机械通气的患者中,16例发生人机对抗的原因。结果 60例机械通气患者中未发生人机对抗的44例,发生人机对抗的16例。其原因包括:气道阻塞7例,占43.75%;紧张、烦躁4例,占25.00%;潮气量不足3例,占18.75%;支气管痉挛1例,占6.25%;急性肺水肿1例,占6.25%。结论气道阻塞是人机对抗的主要原因。如果患者的自主呼吸努力与呼吸机送气不同步甚至对抗,可增加患者呼吸肌做功,增高气道压,减少通气量,并对患者的血流动力学产生不良影响。加强气道管理,设置合适的通气模式和(或)参数,解除气道痉挛,祛除诱因,镇静和(或)肌松等综合治疗措施,可避免和减少人机对抗的产生。
Objective To investigate the man-machine confrontation during mechanical ventilation, which is the specific reason why spontaneous respiration and mechanical ventilation do not co-ordinate, and take appropriate control measures. Methods Retrospective analysis was performed on the causes of man-machine confrontation in 16 of 60 patients who underwent artificial ventilation and mechanical ventilation in the Department of Critical Care Medicine, Second People’s Hospital of Bengbu City, Anhui Province from November 2007 to August 2010. Results In the 60 patients with mechanical ventilation, 44 cases did not occur and there were 16 cases of man-machine confrontation. The reasons include: airway obstruction in 7 cases, accounting for 43.75%; tension, irritability in 4 cases, accounting for 25.00%; tidal volume less than 3 cases, accounting for 18.75%; bronchospasm in 1 case, 6.25%; acute pulmonary edema in 1 case, accounting for 6.25%. Conclusion Airway obstruction is the main cause of man-machine confrontation. If the patient’s spontaneous breathing effort and ventilator breath do not synchronize or even confrontation, can increase the patient’s respiratory muscle work, increased airway pressure, reduce ventilation, and adversely affect the patient’s hemodynamics. Strengthening airway management, setting appropriate ventilation patterns and / or parameters, relieving airway spasms, and eliminating the causes, sedation and / or muscle relaxants and other comprehensive treatment measures can avoid and reduce the production of man-machine confrontation.