肺复张对ARDS患者肺氧合及呼吸力学的影响

The Effects of Lung Recruitment on Lung Oxygenation and Respiratory Mechanics in Patients with ARDS

目的研究肺复张(RM)策略结合肺保护性通气对急性呼吸窘迫综合征(ARDS)患者肺氧合和呼吸力学的影响。方法选择2007年1月-2008年8月30例ARDS患者,随机分为RM组和non-RM组。RM组(n=15):采用肺复张结合小潮气量保护性肺通气治疗。non-RM组(n=15):采用小潮气量保护性肺通气治疗,不使用肺复张。观察2组患者血气指标、呼吸力学及血清肺表面活性蛋白A(SP-A)的变化;脉搏指标剂连续心排量(PiCCo)监测RM组血流动力学变化。结果(1)RM组动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)改善,在24、48、72h同时间点2组PaO2、PaO2/FiO2比较差异有显著性(P<0.01)。(2)RM组气道峰压(PIP)、平台压(Pplat)下降,肺静态顺应性(Cst)升高,在24、48、72h同时间点2组PIP、Pplat、Cst比较差异有显著性(P<0.01)。(3)RM时有一过性血流动力学变化,与RM前比较差异有显著性(P<0.05,P<0.01),但RM结束后120s差异无显著性(P>0.05)。(4)血清SP-A与Cst和PaO2/FiO2呈负相关(r=-0.362,P<0.05;r=-0.394,P<0.05),在72h时2组患者血清SP-A灰度值比较差异有显著性(P<0.05)。结论RM可以使ARDS患者肺泡复张,增加肺气体交换、改善氧合及肺顺应性、降低血清SP-A,对血流动力学影响短暂,安全有效。

Objective To research the effects of lung recruitment on lung oxygenation and respiratory mechanics in patients with acute respiratory distress syndrome （ARDS）. Methods Thirty patients with ARDS from January of 2007 to August of 2008 were enrolled in the study. They were randomized into RM group（n= 15） and non-RM group（n= 15）. The patients in RM group were treated with lung recruitment combined with low tidal volume lung protective ventilation （LPV） strategy. Those in non-RM group were treated with low tidal volume LPV strategy only. Arterial blood gas,respiratory mechanics and the SP level in serum in two groups were observed. Hemodynamic parameters in RM group were monitored with PiCCo care apparatus. Results （1）Compared with non-group, both PaO2 and PaO2/FiO2 in RM group increased more significantly, there were singnificant differences between two groups at 24,48 and 72 h post-ventilation （P〈0.01）. （2）Both the PIP and the Pplat decreased significantly,whereas the Cst increased in RM group. There were significant differences between two groups at 24,48 and 72 h time inter-vals（P〈0.01）. （3）RM could cause significant Hemodynamic parameters change till 120 seconds post-RM（P〈0.01）. （4）The concentration of serum surfactant protein A（SP-A ） was negatively correlated with the Cst and PaO2/FiO2 （r=-0. 362, P〈0.05 ;r=-0. 394, P〈0.05）. The serum contents of SP-A were significantly different in two groups at 72 h post-ventilation（P〈0.05）. Conclusion RM could recruit the collapsed alveolus in patients with ARDS. It could significantly improve lung compliance and oxygenation and decrease the serum contents of SP-A. The effects of RM on hemodynamics were temporary, thus RM was safe and effective for patients with ARDS.