【作者】 张纳新；

【导师】 秦英智；

【作者基本信息】 天津医科大学 ， 急诊医学， 2004， 硕士

【摘要】 目的：研究机械通气条件下血流动力学轻度低下至严重低下时脉波轮廓法（PiCCO）及部分CO₂重复呼吸法（NICO）连续血流动力学监护技术与Swan-Ganz金标准的相关性；观察不同通气模式与NICO血流动力学监护的相互关系，并观察在整个通气过程中血流动力学的动态变化。 方法：选择13例呼吸衰竭行机械通气的患者同时行Swan-Ganz、PiCCO、NICO血流动力学监测，对相应数据进行统计学相关性分析；随机选择32例机械通气患者，观察自主辅助通气模式双水平气道正压（BIPAP）、压力支持通气（PSV）、成比例压力辅助通气（PPS）三模式下血流动力学状态的差异；观察59例机械通气患者自上机第一日至脱机当日动态血流动力学变化趋势。 结果：经直线相关分析，PiCCO法、NICO法均与Swan-Ganz法有较好的相关性；在低辅助机械通气（LAV）期间，心功能接近正常患者三种不同机械通气模式对心功能及肺机械参数影响无明显差异，但以自主呼吸方式（PSV、PPS）可使心功能明显改善，对心功能明显低下者PPS较PSV能明显改善心功能（P＜0.05）；撤机成功组自机械通气开始至LAV之时、由LAV至脱机时CO、CI呈显著性升高，SVR、HR呈显著性下降。 结论：PiCCO及NICO连续血流动力学监测技术可作为ICU机械通气患者床旁监测的可靠手段，从而进一步指导制订有效的治疗策略；PPS通气模式对心功能严重低下之机械通气患者的血流动力学 天津医科大学硕士研究生学位论文的影响最小，较适用于作为该类患者的撤机模式;在机械通气之初直至脱机过程中，了解患者的心功能水平及其在整个治疗过程中的动态变化，对治疗方案的选择、LAV开始时机的选择及成功撤机具有重要的指导意义。更多还原

【Abstract】 Objective: To investigate the agreement between continuous hemodynamic monitor measurements via arterial contour analysis (PICCO), single rebreathing CO2 analysis (NICO) and the clinical gold standard (Swan-Ganz analysis) in ventilated patients with light to seriously low hemodynamic condition; To study the relationship between the . different ventilation modes and hemodynamic monitor by NICO, meantime, to observe the dynamic changes of hemodynamic in the course of ventilation.Methods: 13 ventilated patients with respiratory failure were selected and monitored the hemodynamic values by Swan-Ganz, PiCCO, NICO simultaneously, the corresponsive data were recorded and analysed by linear correlation; Randomized 32 ventilated patients, observed the difference of the condition of hemodynamic when ventilated by bi-level positive airway pressure (BiPAP), pressure supported ventilation (PSV), proportional pressure support (PPS); Observed the change of hemodynamic in 59 ventilated patients from the beginning of the ventilation to the weaning.Results: Linear correlation analysis revealed a good agreement between both PiCCO (Swan-Ganz) and NICO (Swan-Ganz); In the course of low assist ventilation, there’ s no significance difference in cardiac function and lung mechanics among the three kinds of ventilation modes inpatients with nearly good cardiac function, but spontaneous ventilation mode (PSV, PPS) can obviously improved the cardiac function, and PPS can improved the cardiac function more significance than PSV in patients with markedly poor cardiac function (P<0.05) ; The CI, CO showed significance ascent and SVR, HR significance descent from the beginning of the ventilation to LAV and LAV to weaning in successful weaning group.Conclusions: PiCCO and NICO can be used in ventilated patients in ICU as a reliable resort to monitor the continuous hemodynamic beside bed, and then to direct a effective treatment strategy; For the minimally effecting on hemodynamics, PPS mode was suitable to the patients with seriously poor cardiac function as a weaning mode; To value the level of cardiac function of patients and its dynamic changes from the beginning of the ventilation to weaning is very significative to the selection of therapeutic strategy, the occasion when LAV begins and successfully wean.更多还原