不同肺复张方法在肺内源性急性呼吸窘迫综合征治疗中应用比较

Comparative Study of Three Recruitment Maneuvers in Acute Respiratory Distress Sydrome Caused by Pulmonary Disease

目的探讨三种不同的肺复张方法(RM)应用于肺内源性急性呼吸窘迫综合征(ARDS)患者的效果和负影响。方法肺内源性急性呼吸窘迫综合征患者40例,按照交叉设计的方法在不同时段分别应用控制性肺膨胀(SI),呼吸末正压递增法(IP),压力控制法(PCV)三种肺复张方法,记录RM前后患者心率,平均动脉压(MAP),中心静脉压(CVP),氧合指数,肺静态顺应性等指标的变化,并作统计学分析。结果RM后患者短时间内氧合指数和肺静态顺应性都明显增加,SI组30 min和1 h增加幅度较其他两组明显减少(P<0.05),2 h时三组数据之间无明显差别(P>0.05)。RM后患者短时间内均有心率增快,CVP上升,MAP下降,SI组变化幅度最大(P<0.05),20 min后三组数据之间无明显差别(P>0.05)。结论对于肺内源性ARDS行RM,SI对肺顺应性和氧合改善效果最差,对血流动力学影响最大,IP和PCV方法没有明显差别。

Objective To research effects and side effects of three different recruitment maneuvers（RM）in acute respiratory distress syndrome（ARDS）caused by pulmonary disease.Methods40 patients of pulmonary ARDS were undergoed three RM included sustained inflation（SI）;increase progressively PEEP（IP）;pressure control ventilation（PCV）,in different periods according to crossover design methods.Heart rate,mean arterial blood pressure（MAP）,central venous pressure（CVP）,oxygenation index,lung compliance were recorded before and after RM and analysised.ResultsOxygenation index and lung compliance were increased obviously in a short time after RM,30 min and 1 hour ungrade extent of SI group were less than other two groups obviously（P0.05）,after two hours,datas of three groups were similar（P0.05）.After RM,heart rate and CVP were increased,MAP was decreased in a short time,changes of SI group were larger than other two（P0.05）,after 20 min,datas of three groups were similar（P0.05）.ConclusionWhen pulmonary ARDS undergoed RM,SI method was worst effective on increasing oxygenation index and lung compliance,and had most side effect on hemodynamics.IP and PCV methods were similar on these points.