肺复张策略治疗内源性和外源性急性呼吸窘迫综合征效果的比较研究

Comparative Study on Recruitment Maneuvers in Acute RespiratoryDistress Syndrome Caused by Pulmonary and Extrapulmonary Disease

目的对比研究肺复张策略对肺内/外源性急性呼吸窘迫综合征治疗效果。方法18例急性呼吸窘迫综合征机械通气的患者,分肺内源性组和肺外源性组,其中肺内源性急性呼吸窘迫综合征10例,肺外源性急性呼吸窘迫8例。在肺保护性通气策略基础上行肺复张,在镇静、非肌松状态下,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。结果与肺复张前比较,两组复张后10 min3、0 min1、h2、h动脉血气分析氧饱和度、动脉氧分压均有提高(P<0.05),两组比较肺外源性组升高较为明显(P<0.05);复张前后两组二氧化碳分压均无明显变化(P>0.05),呼吸系统顺应性在复张后明显提高(P<0.05);气道峰压、平台压、中心静脉压、平均动脉压在复张过程中时提高(P<0.05),但复张后5 min与治疗前比较没有明显变化(P>0.05);复张前后心率没有明显变化(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,对于肺外源性急性呼吸窘迫综合征治疗效果更明显。

Objective To study the clinical effects of lung recruitment maneuvers （RM） combined with lung protective strategy in acute respiratory distress syndrome （ARDS） caused by pulmonary and extrapulmonary disease（ARDSp/ARDSexp）. Methods Eighteen ventilated patients with ARDS underwent RM using a pressure of 40 cmH20 for 40s, without any neuromuscular blocking agents. Results Compared with before RM,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） in the tWO groups,and respiratory system compliance （Crs） increased markedly after RM （P〈 0.05） in the two groups,but in patients with ARDSexp the improvement was more obvious（P〈0. 05）. There was no significant difference for the partial pressure of carbon dioxide（PaCO2）before and after RM. The peak inspiratory pressures （PIP） ,heart rate （HR） and plateau inspiratory pressures （Pplat） had no significant difference between after and before RM in the two groups. The central vein pressure （CVP） and mean arterial pressure （MAP） had no significant changes after RM （ P〉 0.05）. Conclusion RM could improve oxygenation,Crs and PaO2/FiO2 of the patients with ARDS. This study also suggests that patients with ARDS caused by extrapulmonary disease respond better to RM than ARDS caused by pulmonary disease.