摘要
目的 观察不同水平呼气末正压(PEEP)通气对肺内、外源性急性呼吸窘迫综合征(ARDS)患者的影响。方法 以16例早期肺内源性ARDS(A组)和12例早期肺外源性ARDS(B组)患者为研究对象,调整PEEP水平,分别监测在PEEP通气前和PEEP为5、10、15cmH2O通气后30min时的氧合、呼吸力学和血流动力学的变化。结果 PEEP5cmH2O时与PEEP通气前比较,A、B两组患者的动脉血氧分压(PaO2)/吸入气氧浓度(FiO2)、气道峰压(Ppeak)、气道平台压(Pplat)、平均动脉压(MAP)以及B组患者的呼吸系统顺应性(Crs)差异均无统计学意义(P均〉0.05);A组患者的Crs[PEEP5cmH2O时、PEEP通气前分别为(0.027±0.004)、(0.022±0.005)L/cmH2O]差异有统计学意义(P〈0.05)。PEEP10cmH2O时与PEEP通气前比较,A、B两组患者的PaO2/Fioz[PEEP10cmH2O时、PEEP通气前A组分别为(130.Off=30.6)、(81.6±26.7),B组分别为(137.3±28.9)、(73.6±30.8)]、Crs[PEEP10cmH2O时、PEEP通气前A组分别为(0.032±0.005)、(0.022±0.005)L/cmH2O,B组分别为(0.033±0.005)、(0.022±0.004)L/cmH2O]、MAP[PEEP10cmH2O时、PEEP通气前A组分别为(68.9±8.4)、(79.3±9.2)mEHg,B组分别为(69.0±6.2)、(77.5±8.7)mEHg]以及A组患者的Ppeak[PEEP10cmH2O时、PEEP通气前分别为(33.0±6.O)、(25.0±5.8)mEHg]和PplatFPEEP10cmH20时、PEEP通气前分别为(30.5±5.6)、(22.1±4.8)mEHg]差异均有统计学意义(P〈0.05或P〈0.01),其中B组患者PaO2/FiO2升高幅度、Crs增大幅度均较A组患者更显著(P均G0.05)。PEEP15cmHzO时与PEEP通气前比较,A、B两组患者的PaO2/FiO2[EEP15cmH2O时、PEEP通气前A组分别为(139.8±34.8)、(81.6±26.7),B组分别为(178.7±35.4)、(73.6±30.8)]、Crs[PEEP15cmH2O时、PEEP通气前A组分别为(0.030±0.005)、(0.022±0.005)L/cmH20,B组分别为(0.036±0.007)、(0.022±0.004)L/cmH201、MAP[PEEP15cmH2O时、PEEP通气前A组分别为(66.9±9.1)、(79.3±9.2)mEHg,B组分别为(66.3±5.2)、(77.5±8.7)mEHg]、Ppeak[PEEP15cmH2O时、PEEP通气前A组分别为(40.3±6.7)、(25.0±5.8)cmH2O,B组分别为(35.7±8.5)、(22.2±7.8)cmH2O]和Pplat[PEEP15cmH2O时、PEEP通气前A组分别为(36.9±5.6)、(22.1±4.8)cmH2O,B组分别为(29.2±6.8)、(18.7±5.6)cmH2O]差异均有统计学意义(P均〈0.01),其中B组患者PaO2/FiO2升高幅度、Crs增大幅度均较A组患者更显著(P均〈0.01),A组患者Pplat增高幅度较B组患者更显著(P〈0.01)。A、B两组患者MAP下降幅度比较差异无统计学意义(P〉0.05)。机械通气24h后A组2例出现轻度纵隔气肿。结论 PEEP通气能改善部分ARDS患者的氧合和呼吸系统顺应性,而且对肺外源性ARDS患者的改善可能要优于肺内源性ARDS患者。但高PEEP可能使Ppeak和Pplat显著增高,而且肺内源性ARDS患者Pplat的增高幅度可能要更显著于肺外源性ARDS患者。
Objective To evaluate the effect of different level positive end-expiratory pressure(PEEP) in patients with acute respiratory distress syndrome (ARDS) caused by pulmonary or extrapulmonary diseases. Methods Sixteen patients with ARDS caused by pulmonary diseases (ARDSp, group A) and twelve patients with ARDS caused by extrapulmonary diseases (ARDSexp,group B) within three days of onset of ARDS were included in this study which were classified as two groups. The effect before PEEP ventilation and after PEEP 5, 10, 15 em H2O ventilation about 30 minutes on oxygenation, respiratory mechanics and hemodynamics were observed, respectively. Results No significant differences were found between after PEEP 5 cm H2O ventilation and before PEEP ventilation regarding the partial pressure of oxygen in arterial blood (PaO2) /fraction of inspired oxygen (FiO2), peak pressute( Ppeak), plateau pressure ( Pplat), mean arterial press ure ( MAP), in group A and group B, respectively ( all P 〉 0.05 ), and respiratory compliance (Crs) in group B ( P 〉0.05). Respiratory compliance (Crs) of the group A after PEEP 5 cm H2O ventilation [-(0. 027±0. 004) L/cm H2O] was larger than that before PEEP ventilation [ (0. 022± 0.005 ) L/cm H2O, P 〈 0.05]. Significant differences were found between after PEEP 10 cm H2O ventilation and before PEEP ventilation in group A and group B, respectively, regarding PaO2/FiO2 (130.0 ± 30.6) vs (81.6±26.7),(137.3±28.9) vs (73.6±30.8),Crs (0.032±0.005) L/cm H2O vs (0.022± 0.005) L/cmH2O,(0.033±0.005) L/cmH2O vs (0.022±0.004) L/cmH2O,MAP (68.94-8.4) mm Hg vs (79.3±9.2) mm Hg,(69.0±6.2) mm Hg vs (77.5±8. 7) mm Hg,and in group A regarding Ppeak (33.0±6.0) mm Hg vs (25.0±5.8) mm Hg and Pplat (30.5±5.6) mm Hg vs (22.1±4.8) mm Hg ( P 〈0.05 or P 〈 0.01). And PaO2/FiO2 ,Crs of the group B were more increased than that of the group A (all P 〈0.05). After PEEP 15 cm HzO ventilation and before PEEP ventilation, in group A and group B, respectively,regarding PaO2/FiO2 (139.8±34.8) vs (81.6±26.7), (178.7±35.4) vs (73.6±30. 8) ,Crs (0.030±0.005) L/cm H2O vs (0.022±0.005) L/cm HZO,(0.036±0.007) L/cm H2O vs (0.022±0. 004) L/cm H2O,MAP (66.9±9.1) mm Hg vs (79.3±9.2) mm Hg,(66.3±5.2) mm Hg vs (77.5± 8.7 ) mm Hg,Ppeak (40.3±6.7) cm H2O vs (25.0±5.8) cm H2O, (35.7±8.5) cm H2O vs ( 22.2± 7.8) cm H2O and Pplat (36.9±5.6) cm H2O vs (22.1±4.8) cm HZO,(29.2±6.8) cm H2O vs (18.7± 5.6) cm H2O,the differences were significant (all P 〈0.01). And PaO2/FiO2 ,Crs of group B were more increased than that of group A (all P 〈0. 05). Pplat of group A was more increased than that of group B ( P 〈0.01). But MAP of group A showed no significant decrease with that of group B ( P 〉0. 05). After mechanical ventilation about 24 h, mediastinal emphysema were found in two patients of group A. Conclusions PEEP ventilation could improve PaO2/FiO2 and Crs for some patients with ARDS,and the improvements in ARDSexp could be more significant than in ARDSp. But high PEEP could increase Pplat and Ppeak for the patients with ARDS,and the increase in ARDSp could be more significant than in ARDSexp.
出处
《国际呼吸杂志》
2007年第11期814-818,共5页
International Journal of Respiration
关键词
急性呼吸窘迫综合征
呼气末正压
氧合
呼吸力学
Acute respiratory distress syndrome
Positive end-expiratory pressure
Oxygenatiom Respiratory mechanics