小潮气量结合控制性肺膨胀对肿瘤术后早期急性呼吸窘迫患者的疗效

Clinical effect of lower tidal volume combined with sustained inflation on acute respiratory distress for post operative carcinoma surgery patients.

目的观察小潮气量结合控制性肺膨胀（SI）对肿瘤术后早期呼吸窘迫（ARD）患者的疗效及可能出现的不良反应。方法选择中国医学科学院肿瘤医院和北京协和医院2007年1月至2009年12月收治的肿瘤术后早期ARD患者51例，术后循环稳定，因ARD而不能脱离机械通气。监测并记录其持续无创血压（NBP）、脉搏血氧饱和度（SP02），实行肺保护性通气，予SI治疗，记录SI前及SI后10min、24h和48h的呼吸末正压通气（PEEP）水平及吸入氧浓度（FiO2）；监测呼吸频率（F）、气道平台压（Pplat）、吸入峰值压（Ppeak）、潮气量（VT）、呼吸系统静态顺应性（Cst）及动脉血气分析（ABG）。结果应用SI后，51例肿瘤术后ARD患者FiO2、PEEP减低（F值分别为66．05、241．28，P均〈0．01）；VT、Cst增加（F值分别为262．40、118．28，P均〈0．01）；Ppeak、Pplat、呼吸频率下降（F值分别为88．96、83．05、57．55，P均〈0．01），动脉血气分析改善，未发生各种不良事件。结论sI在肺保护性通气的基础上可改善肿瘤术后ARD患者的氧合。

Objective To study the clinical efficiency and possible side effects of lower tidal volume combined with sustained inflation（SI） on acute respiratory distress syndrome （ARDS） for post operative carcinoma surgery patients. Methods Fifty one hypoxemia post operative carcinoma surgery patients from Jan. 2007 to Dec. 2009 in Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College were included. Their cirrculation was stable. Mechanical ventilation could not be removed due to ARDS. Noninvasive continuous artery blood pressure （ NBP）, pulse oximetric saturation （ SPO2 ）, arterial blood gas （ABG） analysis, static compliance of respiratory system （ Cst ） were monitored and recorded. Patients were ventilated on volume control mode. Tidal volumes （VT） was set to 6 ml/kg. SI were conducted by continuous positive airway pressure of 35 cm H2O, sustaining for 40 seconds. Positive end-expiratory pressure （ PEEP）, FiO2, respiratory rate （F） , Pplateau inspiratory pressures （Pplat） ,the peak inspiratory pressures （Ppeak）, VT, Cst and ABG before SI applying and at 10 min,24 h,48 h after SI applying were measured. Results The level of PaO2 and FiO2 were significantly lowered, VT and Crs increased significantly,Ppeak,Pplat,and F were improved significantly at 10 min,24 h and 48 h after SI in all cases. No complication occurred. All patients were discharged without adverse event. Conclusions Hypoxemia of ARDS following carcinoma surgery could be improved by lower tidal volume combined with SI.