【作者】 李飞；

【导师】 于湘友；

【作者基本信息】 新疆医科大学 ， 麻醉学， 2011， 硕士

【摘要】 目的：通过比较Smart Care/PS和压力支持通气(pressure support ventilation,PSV)模式在困难撤机患者中呼吸力学及血流动力学的变化,比较SC撤机模式与PSV撤机模式的效果。方法：满足撤机条件后,将57例中枢神经系统(central nervous system, CNS)疾病术后与肺部感染的困难撤机患者随机分成两组(SC组和PSV组),基础通气模式均为同步间歇指令通气(synchronized intermittent mandatory ventilation, SIMV)+PSV,分别使用SC和PSV模式进行撤机,收集撤机后5min、15min、30min、1h、2h,5个时间点的呼吸力学及血流动力学指标。采用重复测量方差分析进行数据统计。结果：(1)两种撤机方式各时间点的f、P0.1、NIF、HR比较,差异无统计学意义(P>0.05),不同时间点的f、P0.1、NIF、HR比较,差异有统计学意义(P<0.05)。(2)两种撤机方式各时间点的Vt、PetCO2、C、R、MAP、CI比较,差异无统计学意义(P>0.05),不同时间点的Vt、PetCO2、C、R、MAP、CI比较,差异无统计学意义(P>0.05)。结论：对于CNS疾病术后与肺部感染困难撤机患者来说,SC可代替PSV模式,模拟医师对患者机械通气的压力支持(pressure support, PS)水平的调整,进行自动化撤机。更多还原

【Abstract】 Objective:To compare the variation on hemodynamics and respiratory mechanics of Smart Care/PS and PSV used in difficult weaning patients, in order to evaluate if the Smart Care/PS weaning is superior to PSV weaning. Method:When fifty-seven difficult weaning patients were fitted to the weaning condition, they were randomized into 2 groups:weaning with Smart Care/PS (SC group, n=15)or with pressure support ventilation(PSV group, n=14). The basic ventilation mode was SIMV+PSV before weaning. The two groups used Smart Care/PS and PSV respectively. Parameters of pulmonary mechanics and hemodynamics were measured at 5 min、15 min、30 min、1h and 2h after weaning. The collecting dates were analyzed by repeated measurement analysis of variance. Results:(1) The f、Vt、P0.1、NIF and HR had no significant difference between the two weaning modes (P>0.05); but they had difference at each times (P<0.05). (2) The PetCO2、C、R、MAP and CI had no significant difference between the two weaning modes (P>0.05) and at each times (P>0.05). Conclusion:For those difficult-wean patients caused by postoperative CNS disease and pulmonary infection, Smart Care/PS can take the place of PSV, simulate the doctor judging and dealing with pressure support level according to the patients condition and can be used to automated weaning.更多还原