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目的研究压力调节容量控制通气模式对婴幼儿复杂先天性心脏病术后心肺功能的影响。方法2岁以内复杂先天性心脏病手术患儿50例,平均年龄(7.0±4.9)个月,平均体重(6.3±2.0)kg,使用Siemen’s Servo 300或Maquet Servo i呼吸机机械通气,术后2 h开始进入实验步骤,依次设置呼吸模式为容量控制(VC)→压力调节容量控制(PRVC)→压力控制(PC)→容量控制(VC),需要机械通气超过24 h的患儿,在术后24 h重复实验步骤。监测血流动力学参数和连续心排量,各模式通气30min后记录吸气峰压(PIP),气道平均压(MAP),肺动态顺应性(Cdyn),并评价氧合功能。结果将VC模式作为基础进行比较,在应用PRVC模式时心指数(CI)和每搏指数(SI)有改善(P<0.05),分别上升6.1%和6.6%,其他血流动力学指标无明显改变;应用PRVC和PC模式时PIP比VC模式时降低14.6%和12.7%(P<0.01),Cdyn分别升高23.3%和22.7%(P<0.01),不同的是PC模式还同时表现MAP的升高;与VC模式相比,PRVC和PC模式时呼吸指数(RI)分别下降6.3%和3.4%(P<0.05),肺泡动脉氧分压阶差(A-aDO_2)分别下降3.5%和2.8%(P<0.05),而PaO_2/FiO_2则仅在PRVC模式时明显升高10.4%(P<0.01),再次返回VC模式时所有参数与初次应用VC模式时无差异。术后24 h重复实验步骤,实验结果与首次相似。结论PRVC模式不仅可以降低PIP,提高肺顺应性,改善氧合功能,还能使CI和SI有所增加,婴幼儿复杂先天性心脏病术后应用PRVC通气模式是安全、有效的。
Objective To investigate the effect of pressure-controlled volume-controlled ventilation on cardiorespiratory function in infants with complicated congenital heart disease. Methods Fifty children with complicated congenital heart disease under 2 years of age with an average age of (7.0 ± 4.9) months and mean body weight (6.3 ± 2.0) kg were ventilated with either Siemen’s Servo 300 or Maquet Servo i ventilator and 2 h to enter the experimental procedure, set the breathing mode for the volume control (VC) → pressure regulation volume control (PRVC) → pressure control (PC) → volume control (VC), requiring mechanical ventilation in children over 24 h after surgery 24 h Repeat the experimental procedure. The parameters of hemodynamics and continuous cardiac output were monitored. PIP, MAP and Cdyn were recorded after ventilation for 30 minutes in each model, and the oxygenation function was evaluated. Results Compared with VC model, CI and PI were improved (P <0.05) in PRVC mode by 6.1% and 6.6% respectively, while no significant difference was observed in other hemodynamic parameters PIP decreased by 14.6% and 12.7% (P <0.01), and Cdyn increased by 23.3% and 22.7% (P <0.01), respectively, in PRVC and PC modes, except that PC mode also showed MAP (P <0.05); and the respiratory index (RI) of PRVC and PC decreased by 3.5% and 3.4% respectively (P <0.05) % (P <0.05), while PaO 2 / FiO 2 increased significantly by 10.4% (P <0.01) only in PRVC mode. No difference was found when returning to VC mode again. The experimental procedure was repeated 24 h after the operation, and the experimental results were similar to those for the first time. Conclusions PRVC can not only reduce PIP, improve lung compliance, improve oxygenation function, but also increase CI and SI. It is safe and effective to apply PRVC ventilation model in infants with complicated congenital heart disease.