肺复张法密闭式吸痰对急性呼吸窘迫综合征患者肺换气功能的影响

Effects of Lung Recruitment Manoeuvres After Closed Endotracheal Suctioning on Ventilation Function of Patients with Acute Respiratory Distress Syndrome

目的探讨肺复张(RM)法密闭式吸痰对急性呼吸窘迫综合征(ARDS)机械通气患者肺换气功能的影响。方法选择30例需机械通气的ARDS患者,在基础通气稳定30min后,每例患者按随机顺序分别采用单纯密闭式吸痰(下称单纯法)、复张法密闭式吸痰(吸痰后立即实施1次RM,下称复张法)各1次,2次吸痰间隔60min。观察记录患者在不同吸痰方式下,吸痰前后动脉血气分析指标和氧化谢指标,吸痰前、中、后血流动力学指标的变化及吸痰后SpO2恢复至吸痰前水平所需时间。结果两种方式吸痰前后患者血流动力学指标无显著性变化(均P>0.05);单纯法吸痰后患者PaO2、SaO2、SpO2较吸痰前显著降低(均P<0.01);复张法吸痰前后上述指标比较,差异无显著性意义(均P>0.05);SpO2恢复至吸痰前水平复张法所需时间显著短于单纯法(P<0.01)。结论ARDS患者在吸痰后立即实施RM可以纠正吸痰所致的低氧,且血流动力学未受到明显影响,安全可靠。

Objective To investigate the influence of lung recruitment manoeuvres after closed endotracheal suctioning （CETS） on ventilation function of patients with acute respiratory distress syndrome （ARDS） subject to mechanical ventilation. Methods A total of 30 consecutive mechanically ventilated patients with ARDS were included. Two suctioning procedures were performed in each patient. In the first procedure, lung recruitment manoeuvres were performed following CETS immediately, and after 60 rain another CETS （without lung recruitment manoeuvres） was performed. Before （baseline） and 3 rain after each CETS procedure, the value of blood gas [pH, partial arterial oxygen tension （PaO2）, arterial oxygen saturation （SaO2）], pulse oximetry （SpO2） and hemodynamic parameters [heart rate （HR）, central venous pressure （CVP）, mean arterial pressure （MAP）] were observed and the time for SpO2 to return to baseline was measured. Results After both CETS, the hemodynamic parameters kept stable （P〉0.05 for all） ; PaO2, SaO2, SpO2 dropped sigificantly after CETS without lung recruitment manoeuvres （P〈0.01 for all）, while the above indicators after CETS with lung recruitment manoeuvres were unchanged significantly （P〉0.05 for all）. The time for SpO2 to return to baseline after CETS with lung recruitment manoeuvres was significantly shorter than CETS without lung recruitment manoeuvres （P〈0.01）. Conclusion Lung recruitment manoeuvres immediately following closed endotracheal suctioning could correct hypoxia in ventilated patients with ARDS, and it＇s safe and reliable.