肺复张策略治疗急性呼吸窘迫综合征的临床分析

Effects of Lung Recruitment Maneuvers in Patients with Acute Respiration Distress Syndrome

目的探讨肺复张策略结合保护性通气对急性呼吸窘迫综合征肺复张的疗效和安全性。方法16例急性呼吸窘迫综合征机械通气患者行肺复张,在镇静、非肌肉松弛状态下,采用高水平持续正压通气,呼吸末正压为40 cm H2O,持续时间40 s。结果与复张前比较,复张后动脉血气分析氧饱和度、动脉氧分压均有提高,10 min、30 min1、h、2 h提高有统计学意义(P<0.05);二氧化碳分压无明显变化(P>0.05);气道峰压、平台压在肺复张前后无明显变化(P>0.05),呼吸系统顺应性在复张后明显提高(P<0.05);中心静脉压、平均动脉压在复张过程中提高(P<0.05),但复张后5 min与治疗前比较没有明显变化(P>0.05),而心率也没有明显变化(P>0.05)。结论肺复张措施对急性呼吸窘迫综合征患者能改善氧合,对血流动力学影响短暂,安全有效。

Objective To investigate the clinical effects and safety of recruitment maneuvers （RM） combined with lung protective strategy in patients with acute respiratory distress syndrome （ARDS）. Methods Sixteen ventilated patients with ARDS underwent RM using a pressure of 40 cmH2O for 40s, without any neuromuscular blocking agents. Results After RM treatment, both arterial oxygen saturation （SaO2）and partial pressure of arterial oxygen （PaO2） were significantly increased in 10 min,30 min,1 hr and 2 hr （P〈0.05）. There was no significant difference in the partial pressure of carbon dioxide（PaCO2 ）before and after RM （P〉0. 05）. The peak inspiratory pressures （PIP）, heart rate （HR） and plateau inspiratory pressures （Pplat） had no significant difference between after and before RM（P〉0.05）,but respiratory system compliance （Crs） increased markedly after RM （P〈0.05）. The central vein pressure （CVP） and mean arterial pressure （MAP） increased during recruitment （P〈 0.05） ,but there was no significant difference after RM（P〉0.05）. Conclusion RM can improve oxygenation,Crs and PaO2/ FiO2 of the patients with ARDS. This study also suggests that RM is safe for hemodynamics.