天津医药

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不同机械通气参数对胃内压和消化功能的影响

赵晓赟,李月川,李冠华,张力,贾玮,焦丽娜,杨学瑾   

  1. 天津市胸科医院胸内科
  • 收稿日期:2012-09-07 修回日期:2013-01-18 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 李月川

Effects of Different Ventilation Modes and Parameters on Intragastric Pressure and Digestive Function

ZHAO XIAO YUN1,LI YUE CHUANLI GUAN HUA1,ZHANG LI1, JIA Wei 1,JIAO Lina 1,YANG Xuejin 1   

  • Received:2012-09-07 Revised:2013-01-18 Published:2013-07-15 Online:2013-07-15
  • Contact: LI YUE CHUAN

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摘要：

【摘要】 目的   探讨不同机械通气模式及参数对胃内压力和消化功能的影响。方法  选取因慢性阻塞性肺疾病伴呼吸衰竭行机械通气的40例患者,当病情稳定后,在PSV、SIMV、CMV3种通气模式及0、5、10cmH2O3组呼气末正压(PEEP)参数下,监测患者的平均气道压(ITP)、胃内压(IGP)、胃排空时间、胃液pH值、胃液胆汁酸(TBA)并进行比较。结果 (1)3种机械通气模式下,PSV组的ITP最低,CMV组最高,SIMV组居中;随着ITP的增加,IGP也基本呈增加趋势,故CMV对IGP的影响最大(P<0.01)。在不同PEEP值时,PEEP越大,ITP越高,对IGP的影响也越大(P<0.01)。(2)在3种通气模式和设置不同PEEP值时,ITP越高,胃排空时间越短,胃液TBA越高(P<0.05),而胃液pH值未观察到显著变化(P>0.05)。结论  不同的机械通气模式和参数设置通过ITP对IGP、胃排空等产生不同程度的影响,选择合理的机械通气参数可在一定程度上改善消化功能。 

关键词: 通气机, 机械, 平均气道压, 腹内压, 胃内压

Abstract: [Abstract]  Objective   To study the effect on intragastric pressure and digestive function by different mechanical ventilation modes and parameters. Method   The authors selected 40 inpatients from Janurary,2007 to June,2009 who suffered respiratory failure to carry out a prospective study. In different modes and parameters of mechanical ventilation, a multi-channel physiological signal recording device was used to monitor the patients with intra-trachea pressure(ITP), intra-gastric pressure(IGP) synchronously, as well as the emptying time of stomach, PH value and totle bile acid(TBA) concentration in gastric fluid. Result   First, no matter which type of ventilation mode or PEEP parameters was selected, as long as lower ITP, can reduce IGP. The highest IGP was found in CMV group(P<0.01) from the three various of ventilation mode(P<0.01), as well as in PEEP10 group from the three PEEP settings(P<0.01). Second, under mechanical ventilation support, when ITP increased, emptying time of stomach decreased (P<0.01), so as concentration of TBA (P<0.05). However, there was no significant change in PH of gastric fluid(P>0.05). Conclusion   Various mechanical ventilation modes and parameter settings induced different ITP, thereby affecting the IGP and gastric emptying. Maybe we can promote digestive function by choosing the appropriate mechanical ventilation mode and parameters.

Key words: Intra trachea pressure, intra-abdominal hypertension, Intragastric pressure