靶向支气管肺泡灌洗治疗肺源性急性呼吸窘迫综合征的比较研究

Comparative study of targeted BAL for acute respiratory distress syndrome from pulmonary origin

目的评价肺泡灌洗(BAL)对肺源性急性呼吸窘迫综合征(ARDSp)的治疗作用。方法以20例血液动力学稳定、接受机械通气的ARDSp患者为研究对象,随机分为常规治疗组(简称常规组)与支气管肺泡灌洗组(简称BAL组),观察两组治疗前及治疗2h和4h后气道峰压(Ppeak)、气道平台压(Pplat)、平均气道压(Pmean)、肺静态顺应性(Cst)在相同呼气末正压(PEEP)条件下的变化趋势及PaO2/FiO2治疗前后的变化。结果相同PEEP条件下BAL组治疗后较治疗前Ppeak、Pplat、Pmean有显著下降(P<0.05),Cst明显增高(P<0.05),PaO2/FiO2有显著升高(P<0.05),与常规治疗组比较Ppeak、Pplat、Pmean亦有显著下降(P<0.05),PaO2/FiO2有显著升高(P<0.001);常规治疗组Ppeak、Pplat、Pmean较治疗前增高,Cst下降,PaO2/FiO2有升高,但差异无显著性(P>0.05)。结论BAL能降低ARDSp的气道压力及肺的顺应性,从而改善肺通气功能及氧合。

[ Objective] To study the effects of targeted bronchoalveolar lavage （BAL） on acute respiratory distress syndrome （ARDS） from pulmonary origin （ARDSp）. [Methods] 20 ARDSp patients receiving IPPV were divided into two groups： traditional treatment group and BAL group based on whether they had BAL,then the changes in peakinspiratory pressure （Ppeak）, platform pressure （Pplat）, mean airway pressure （Pmean）, pulmonary compliance （Cst） and PaO4 FiO2 were compared in the two groups before and 2 hours, 4 hours after treatment. [Results] Under the same PEEP, Ppeak、Pplat and Pmean in BAL group decreased evidendy （P 〈 0.05） ,and Cst and PaO2/FiO2 increased evidendy （P 〈 0.05） 2 hours, 4 hours after treatment than before treatment and the traditional treatment group （P 〈 0.001）, but the Ppeak、Pplat and Pmean were increased in traditional treatment group, Cst decreased. Although PaO2/FiO2 increased, there was no significance （P 〉 0.05）. [Conclusion] BAL could decrease the airway pressure and increase pulmonary compliance in ARDSp patients, then improve patients＇ ventilation and oxygenation.