Poelaert J I, Visser C A, Everaert J A, Koolen J J, Colardyn F A
Department of Intensive Care, University Hospital, Ghent, Belgium.
Chest. 1993 Jul;104(1):214-9. doi: 10.1378/chest.104.1.214.
Twelve patients with the adult respiratory distress syndrome were included in this study and evaluated by transesophageal echocardiography and Doppler, assessing right and left ventricular intracardiac blood flow alterations with progressive increase of inspiration-to-expiration (I-E) ratios. Whereas midpulmonary artery flow parameters did not show any change, early left ventricular filling demonstrated a significant increase after switching the ventilatory mode from volume to pressure-controlled ventilation with 2:1 I-E ratio (end-inspiration: 39 +/- 26 cm with positive end-expiratory pressure [PEEP]-ventilation to 68 +/- 56 cm with pressure-controlled inverse-ratio ventilation, 2:1; p < 0.01; at end-expiration, from 67 +/- 21 cm with PEEP-ventilation to 83 +/- 36 cm with pressure-controlled ventilation 1:1; p < or = 0.05), resulting probably from different ventilatory flow and pressure curves. In the meanwhile, cardiac index demonstrated a significant augmentation (from 4.73 +/- 1.71 L/min.m2 to 5.56 +/- 1.66 L/min.m2; p < 0.05). Pressure-controlled inverse ratio ventilation results in both respiratory and hemodynamic advantages as is demonstrated by this study.
本研究纳入了12例成人呼吸窘迫综合征患者，并通过经食管超声心动图和多普勒进行评估，随着吸气与呼气（I-E）比值的逐渐增加，评估左右心室内血流变化。虽然肺中动脉血流参数未显示任何变化，但在将通气模式从容量控制通气转换为压力控制通气且I-E比值为2:1后，左心室早期充盈显著增加（呼气末：呼气末正压[PEEP]通气时为39±26 cm，压力控制反比通气时为68±56 cm，2:1；p<0.01；呼气末，PEEP通气时为67±21 cm，压力控制通气1:1时为83±36 cm；p≤0.05），这可能是由于不同的通气流量和压力曲线所致。同时，心脏指数显著增加（从4.73±1.71 L/min·m²增至5.56±1.66 L/min·m²；p<0.05）。本研究表明，压力控制反比通气在呼吸和血流动力学方面均具有优势。
