急性呼吸窘迫综合征患者肺血流及呼吸力学变化的临床观察

Clinical study on changes of pulmonary blood flow and respiratory mechanics in patients with acute respiratory distress syndrome

目的 利用NICO无创心肺功能监测系统观察急性呼吸窘迫综合征（ARDS）患者肺血流动力和呼吸力学的变化,探讨ARDS患者低氧血症的病理生理学机制.方法 选择2006年1月～2009年12月上海市长征医院加强监护病房（ICU）收治的61例符合ARDS诊断标准的患者作为研究对象,运用NICO无创心肺功能监测系统,持续监测患者心排指数（CI）、每搏容量（SV）、肺毛细血管血流量（PCBF）、肺动态顺应性（Cdyn）、呼气末CO2 排出量（ETCO2）、每分钟CO2排出量（VCO2）、每分钟肺泡通气量（MValv）、平均气道压（Pm）、吸气峰压（PIP）、气道阻力（Raw）、呼吸浅快指数（RSBI）及死腔容量与潮气量之比（Vd/Vt）的变化,利用血气分析仪检测患者动脉血氧分压（PaO2）的变化,对照组选择同期收治入院排除胸（肺）部病变的18例患者.结果 ARDS 组与对照组患者CI、SV两项分别比较差异均无统计学意义（P〉0.05）,PCBF、Cdyn、ETCO2 、VCO2、MValv、Pm、PIP、Raw、RSBI、Vd/Vt及PaO2/FiO2各项两组分别比较差异均有统计学意义（P〈0.01或P〈0.05）.结论 运用NICO无创监护系统连续监测发现,ARDS患者左心室收缩功能尚未遭到严重损害,但出现肺内分流、肺灌注受损及通气血流比例失调,可能是导致ARDS患者低氧血症的主要病理生理改变;研究还发现,本组患者病情相对较危重,跨肺压过高,存在间质气肿和肺水肿;ARDS患者动态肺顺应性显著性下降,肺组织弹性差.NICO无创监护系统动态监测RSBI和Vd/Vt也可作为评价ARDS患者病情严重性的指标.

Objective The study was designed to observe the changes of volume of pulmonary blood flow and respiratory mechanics in patients with acute respiratory distress syndrome （ARDS）. Methods 61 patients suffered with ARDS from Jan 2006 to Dee 2009 were picked in intensive care unit （ICU） of Changzheng hospital and the changes of cardiac index（ C I）, strike volume （SV）, pulmonary capillary blood flow （ PCBF）, dynamic compliance （ Cdyn ）, end expiration of CO2 （ ETCO2 ）, minute output of CO2 （ VCO2 ）, minute alveolar ventilation （ MValv）, mean airway pressure （Pm ）, peak inspiratory pressure （ PIP ）, airway resistance （ Raw ）, rapid shallow breathing index （ RSBI ）, ratio of dead space volume and tidal volume（Vd/Vt） were collected by NICO cardiorespiratory monitoring system. We also measure the changes of PaO2/ FiO2 by blood gas analyzer. Patients in control were picked who were admitted in the corresponding time period. Results The changes of CI and SV were no difference （ P 〉 0.05 ）, but PCBF, Cdyn, ETCO2, VCO2, MValv, Pm, PIP, Raw, RSBI, Vd/Vt and PaO2/FiO2 were significant differences （P 〈 0. 05 or P 〈 0. 01 ） Conclusion Using the NICO cardiorespiratory monitoring system,we find that there are pulmonary shunt, misperfusion and disproportion of ratio of ventilation and blood flow though less dysfunction of left ventricular systole in patients with ARDS. We also find that the state of the patients was critical as higher transpuhnonary pressure, mesenchymal emphysema and pneumonedema. There is significantly descending in dynamic compliance and in＇esilienee in ARDS patients. Successive RSBI and Vd/Vt are the means to evaluate severity of ARDS patients by NICO eardiorespiratory monitoring system.