两种肺复张方法治疗急性呼吸窘迫综合征的效果比较

Comparison of the effects of two types of recruitment maneuver used in patients with ARDS

目的 探讨和比较控制性肺膨胀（sustained inflation,SI）和压力控制通气（pressure controlled ventilation,PCV）用于急性呼吸窘迫综合征（ARDS）患者肺复张的效果,及其对血流动力学和呼吸力学方面的影响.方法 对10例ARDS患者采取随机对照实验,在镇静、非肌松状态下,先后采用SI[40cmH2O（1 cmH2O=0.0981 kPa）,40 s]和PCV（20 cmH2O,2 min）进行肺复张,中间间隔洗脱期.收集两种方法复张前（T0）、复张后5 min（T2）、1 h（T3）的血气分析、血流动力学指标、呼吸力学指标和复张中（T1）的呼吸力学与血流动力学指标.收集数据行单因素重复测量方差分析.结果 （1）两种方法T2和T3时点PaO2较T0均明显改善（P〈0.05）,方法间差异无统计学意义（P〉0.05）.PaCO2在各时点差异均无统计学意义（P〉0.05）.（2）两种方法T1时点CI均下降（P〈0.05）,方法间无差异（P〉0.05）.HR、MAP在各时点差异均无统计学意义（P〉0.05）.（3）两种方法T2和T3时点FRC较T0均增加（P〈0.05）,T1时点CS均有所改善（P〈0.05）,方法之间差异无统计学意义（P〉0.05）,Pplat在各时点差异均无统计学意义（P〉0.05）.结论 SI和PCV肺复张对ARDS患者PaO2、FRC、肺复张中Cs均有明显改善,肺复张对CI均有影响,两种方法效果相同.

Objective To investigate and compare the effects of sustained inflation （SI） and pressure controlled ventilation （PCV） on lung recruitment in patients with ARDS, and on hemodynamics and respiratory mechanics of patients. Methods Ten patients with ARDS were included in this randomized clinical trial （ RCT）, and SI （40 cmH20, 40s） and PCV （20 cmH20, 2 min） were successively applied to each patient under sedation, non-muscle relaxation state. There was a elution period between two types of recruitment maneuver （RM）. Parameters of respiratory mechanics, gas exchange and hemodynamics were measured before RM （T0）, 5 min after RM （T2） and one hour after RM （T3）. Parameters of respiratory mechanics and hemodynamics were measured during the period of RM （Tl）. Results （1） The PaO2 at T2 and T3 increased significantly in comparison with that at To （ P 〈 0.05）, and there was no significant difference in PaO2 between two types of RM （P 〉 0.05）. There were no significant differences in PaCO2 between two types of RM at each interval （P 〉 0.05）. （2） The cardiac index （ CI） at T1 decreased significantly compared with that at To in two types of RM （P 〈 0.05）, but there was difference in CI between two types of RM （P 〉 0.05）. There were no differences in MAP and HR at these intervals （P 〉 0.05）. （3） The functional residual capacity （FRC） at T2 and T3 increased significantly in comparison with that at To in two types of RM （P 〈 0.05）. The static compliance （Cs） at T1 improved significantly （P 〈 0.05）, but there was no difference in Cs between two types of RM （ P 〉 0.05）. There was no difference in plateau pressure （Pplat） at all intervals （P 〉0.05）. Conclusions The oxygenation, FRC, and Cs improve significantly in both SI-RM and PCV-RM, and the effects of two types of RM are similar. The SI-RM and PCV-RM have the similar impact on circulatory system during RM.