肺复张手法和肺开放策略在肺内型成人呼吸窘迫综合征中的临床观察：附6例报告

Application of recruitment maneuver and open-lung approach in patients with pulmonary acute respiratory distress syndrome：a report of 6 cases

目的观察肺复张手法（RM）和肺开放策略（OLA）在肺内型成人呼吸窘迫综合征（ARDS）机械通气患者中应用的有效性和安全性。方法肺内型ARDS患者6例，按需进行RM（30—35cm H2O，30～40S），中等PEEP[（12．1±2．0cmH2O）]保持开放。记录RM前后的最低和最高指尖氧饱和度（SO2，脉氧计）、动脉血气。结果SO2于复张后（3．7±2．0）min开始上升，（86．1±89．0）min升至较为稳定的高水平，在中等PEEP水平下维持〉5h，并显著改善患者SO2；复张前（88±5）％与复张后（97±2）％比较，差异有统计学意义（P=0．000）。结论单次肺复张手法和肺开放策略在短期内可迅速、安全、有效改善有基础肺疾病的（严重肺气肿、肺大疱除外）肺内型ARDS患者的SO2，并维持于较高水平。

Objective TO observe the effects and safety of recruitment maneuver （RM） and open-lung approach （OLA） in mechanical ventilated patients with pulmonary acute respiratory distress syndrome （ARDS）. Methods 6 cases of pulmonary ARDS were treated with RM （30 -35 cm H2O,30 -40 s） and OLA（PEEP = 12.1 ± 2.0 cm H2O ）. SO2 and artery blood gas were recorded. Results SO2 began to rise in （ 3.7 ± 2.0 ） rain after RM, reaching plateau at （ 86.1 ± 89.0 ） rain, which was maintained longer than 5 hours by moderate level of PEEP. The RM and OLA significantly improved SO2 [ （ 88 ±5 ） % vs （ 97 ± 2 ） % , P = 0. 000 ]. Conclusion Single RM and OLA can rapidly improve SO2 and maintained it at a higher level in pulmonary ARDS patients with basic pulmonary disease （severe emphysema and bulla are excluded）.