肺复张通气策略在急性呼吸窘迫综合征治疗中的临床应用

Clinical Application of Lung Recruitment Maneuvers in the Treatment of Acute Respiratory Distress Syndrome

【目的】探讨肺复张通气策略治疗急性呼吸窘迫综合征(ARDS)的疗效和风险。【方法】随机将ARDS患者分成对照组和治疗组,对照组在常规治疗的基础上,应用PB760呼吸机采用小潮气量和最佳呼吸末正压(PEEP)的肺保护性通气策略进行机械通气,治疗组在对照组的机械通气治疗基础上再应用肺复张策略。记录肺复张前及肺复张后12 h2、4 h、72 h的氧合指数(PaO2/FiO2)、动脉二氧化碳分压(PaCO2)以及是否出现气压伤等并进行对比分析。【结果】治疗组与对照组比较在肺复张后12 h、24 h、72 h的氧合指数(PaO2/FiO2)均明显改善(P<0.05)、PaCO2均明显降低(P<0.01),两组气压伤发生率差异无显著性(P>0.05)。【结论】采用小潮气量和最佳PEEP联合肺复张策略治疗ARDS是安全有效的。

[Objective]To investigate the effect and risk of lung recruitment maneuvers（RM） in treating acute respiratory distress syndrome （ARDS）. [Methods] ARDS patients were randomly divided into the control group and the treatment group. In addition to conventional treatment, the control group received mechanical ventilation by using lung protective ventilation strategy of applying small tidal volume via PB760 respiratory machine and optimal positive end-expiratory pressure （PEEP）. In addition to the same treatment as the control group, the treatment group further received RM. Oxygen indexes （PaO2/FiO2） before applying RM and at 12h, 24h, 72h after applying RM were measured. The rate of carbon dioxide elimination （PaCO2） in arterial blood and the appearance of ventilator-associated lung injury were compared and analyzed. [Resuhs]In comparison to the control group, the treatment group significantly improved in oxygen indexes （PaO2/FlO2） at 12h, 24h, and 72h after applying RM （ P 〈0.05）, and the level of PaO2 also significantly lowered （ P〈 0.05）. No significant difference was found between the two groups in the occurrence rate of ventilator-associated lung injury. [Conclusion]The employment of small tidal volume and optimal PEEP in conjunction with lung recruitment maneuvers （RM） to treat ARDS is both safe and effective.