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目的 探讨在心肺复苏期间的高级生命支持阶段,持续的胸外心脏按压下的机械通气,较高水平的峰流速(55～70 L/min)是否是一个合适的呼吸机参数设置范围,如果不是则探讨其对策.方法按入院顺序经排除标准,共有30例心脏骤停患者入选,其中男20例,女10例,年龄(51.3±11.6)岁,病因为心肌梗死、肺心病和脑血管意外等.在持续胸外心脏按压下,机械通气选择容量控制(volume control ventilation VCV)模式及减速波型,其他参数不变,当吸气峰流速分别为70 L/min、65 L/min、60 L/min、和55 L/min时,测量吸气相气道峰压值,然后分析不同峰流速对气道峰值压力的影响.每组完成15～30例的数据收集和统计.结果当峰流速分别为70 L/min、65 L/min、60 L/min和55 L/min时,患者平均气道峰压高值为(59.3±9.7)cmH2O、(54.1±9.2)cmH2O、(50.6±8.9)cmH2O和(45.1±8.85)cmH2O,气道峰压高值＞40 cmH2O的发生率分别为93.3%、93.3%、90%、80%,气道峰压高值＞50 cmH2O的发生率分别为73.4%、66.6%、63.4%和43.3%.气道峰压高值＞60 cmH2O的发生率分别为46.7%、33.3%、26.7%和10%.峰流速在70 L/min到55 L/min范围内,每改变5 L/min,气道峰压相应变化5 cmH2O左右,峰流速每改变10 L/min,气道峰压变化存在统计学差异.结论 心肺复苏时的机械通气,选择较高水平的峰流速(55~70 L/min),即使小幅度峰流速的改变,也会导致气道峰压明显地变化.60~70 L/min的峰流速十分容易反复触发气道高压报警,严重影响呼吸机对呼吸支持的效果,因此压力控制模式不适合CPR期间的机械通气.如果峰流速设置为55 L/min,根据患者的实际情况,适当上调气道高压报警的上限是必要的.“,”Objective To explore whether higher levels peak flow (55～70 L/min) are a suitable range of ventilator pa?rameters setting under continuous chest compression on advanced life support stage during cardiopulmonary resuscita?tion(CPR). if not, Explore its countermeasures. Methods Thirty patients with cardiac arrest, 20 males and 10 females, age(51.3±11.6), with the underlying diseases of cardiac infarction, cor pulmonale, cerebral vascular accident, etc. who were collected according to the admission order underwent mechanical ventilation choosing volume control ventilation (VCV) mode and using decreasing–wave with continuous extracorporeal heart pressure. The other parameters being unchanged, the peak inspiratory pressure were measured when the inspiratory peak flow was 70 L/min, 65 L/min, 60 L/min and 55 L/min respectively, and then the effect of different peak flows on the peak airway pressure in the patients was analyzed. The data of 15 to 30 cases in each group were collected and analyzed. Results When the peak flow were 70 L/min, 65 L/min, 60 L/min, and 55 L/min respectively, the values of mean peak airway pressure were(59.3±9.7) cmH2O、(54.1±9.2)cmH2O、(50.6±8.9)cmH2O、and(45.1±8.85)cmH2O respectively.,the incidence rates of peak air?way pressure higher than 40 cmH2O was 93.3%, 93.3%, 90%, and 80% respectively, the incidence rates of peak airway pressure higher than 50 cmH2O were 73.4%, 66.6%, 63.4%, and 43.3% respectively, the incidence rates of peak air?way pressure higher than 60 cmH2O were 46.7%, 33.3%, 26.7%, and 10% respectively. When the peak flow was in the range of 70 L/min to 55 L/min, for every 5 L/min change, the peak pressure of the airway changed for about 5 cmH2O;and for every 10 L/min change there was a statistical difference in the changes of peak airway pressure. Conclusion Higher peak flow ( 55~70 L/min),even a small change of inspiratory flow will cause a significant change in the peak airway pressure, The peak flow rate of 60~70 L/min is easy to trigger the airway high pressure alarm repeatedly, thus. seriously affecting the effect of ventilator in respiratory support. So the pressure control mode is not suitable for mechan?ical ventilation during CPR. If the peak flow is 55 L/min, it is necessary to adjust the upper limit of the airway high pressure alarm according to the actual situation of the patient.