同步间歇指令通气与持续气道正压通气期间压力时间乘积的比较。
Comparison of the pressure time product during synchronous intermittent mandatory ventilation and continuous positive airway pressure.
作者信息
Manczur T, Greenough A, Rafferty G F
机构信息
Departments of Child Health and Respiratory Medicine, King's College Hospital, London SE5 9RS, UK.
出版信息
Arch Dis Child. 2000 Sep;83(3):265-7. doi: 10.1136/adc.83.3.265.
OBJECTIVE
To compare the effect of continuous positive airway pressure (CPAP) with synchronous intermittent mandatory ventilation (SIMV) during weaning, by measurement of the pressure time product (PTP). The PTP is an estimate of the metabolic work or oxygen consumption of the respiratory muscles.
PATIENTS
Forty children, median age 14 months (range 1 month to 17 years) were studied immediately prior to extubation.
METHODS
The PTP, derived from airway pressure changes, was measured while the child received SIMV (with or without pressure support) and then CPAP. A pneumotachograph was placed between the endotracheal tube and ventilator circuit. Its flow signal was used to indicate the beginning and end of inspiration. Airway pressure was measured from the pneumotachograph and the area subtended by the pressure curve (PTP) calculated using a modified Labview programme.
RESULTS
The median PTP was significantly lower on SIMV (17.1 cm H(2)O/sec/min, range 0.4 to 60. 5) compared to on CPAP (32.6 cm H(2)O/sec/min, range 0.1 to 116.7), p < 0.001.
CONCLUSION
These results suggest SIMV, rather than CPAP, may be the more efficacious weaning mode in children, and that the time spent on CPAP during weaning should be minimised.
目的
通过测量压力时间乘积（PTP），比较持续气道正压通气（CPAP）与同步间歇指令通气（SIMV）在撤机过程中的效果。PTP是呼吸肌代谢功或氧消耗的一个估计值。
患者
对40名儿童进行研究，这些儿童在拔管前即刻接受研究，年龄中位数为14个月（范围1个月至17岁）。
方法
在儿童接受SIMV（有或无压力支持）及随后接受CPAP期间，测量源自气道压力变化的PTP。在气管插管与通气机回路之间放置一个呼吸流速计。其流量信号用于指示吸气的开始和结束。从呼吸流速计测量气道压力，并使用改良的Labview程序计算压力曲线所围成的面积（PTP）。
结果
与CPAP时（32.6厘米水柱/秒/分钟，范围0.1至116.7）相比，SIMV时的PTP中位数显著更低（17.1厘米水柱/秒/分钟，范围0.4至60.5），p<0.001。
结论
这些结果表明，对于儿童，SIMV而非CPAP可能是更有效的撤机模式，并且撤机期间使用CPAP的时间应减至最少。
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