肺复张对急性呼吸窘迫综合征患者呼吸力学及血管外肺水指数的影响

Effect of lung recruitment on respiratory mechanics and extravascular lung water index in patients with ARDS

目的 探讨肺复张（RM）对急性呼吸窘迫综合征（ARDS）患者呼吸力学及血管外肺水指数（EVLWI）的影响.方法 采用随机对照病例研究方法,选择30例ARDS患者,随机（随机数字法）分为RM组和Non-RM组.RM组：保护性肺通气稳定后0.5 h开始RM治疗,每12 h重复1次RM,连续3d.Non-RM组：保护性肺通气治疗,不使用RM.收集两组患者治疗前、治疗12 h,24 h,48 h,72 h各时间点氧合指数（PaO2/FiO2）、气道峰压（PIP）、气道平台压（Pplat）、静态肺顺应性（Cst）及EVLWI数据;监测RM前后血流动力学变化.数据处理采用单因素方差分析、成组t检验和Fisher确切概率法.结果 ①治疗后两组患者PaO2/FiO2均呈上升趋势,在12 h,24 h,48 h,72 h同时间点比较RM组高于NonRM组（P＜0.05）;PIP、Pplat值在治疗后均呈下降趋势,RM组低于Non-RM组（P＜0.05）,Cst在治疗后呈升高趋势,RM组高于Non-RM组（P＜0.05）.②治疗后两组EVLWI均呈下降趋势,组内各时间点比较差异有统计学意义（F值分别为22.392、8.147,均P＜0.01）;在12 h,24 h,48 h,72 h同时间点两组EVLWI比较,RM组低于Non-RM组（P＜0.05或P＜0.01）.③RM时有一过性血流动力学变化,与RM前比较差异有统计学意义（P＜0.01）,但RM结束后120 s与RM前比较差异无统计学意义（P＞0.05）.结论 RM可以减少ARDS患者EVLWI,改善肺氧合及肺顺应性,对血流动力学影响短暂.

Objective To study the effects of recruitment maneuver （RM） strategy on respiratory mechanics and extravascular lung water index （EVLWI） in patients with ARDS. Method Thirty patients with ARDS were randomly divided into RM group and non-RM group. In the RM group, the patients were stabilized with basic mechanical ventilation support for 30 minutes, and then the RM was carried out and repeated once every 12 hous for 3 days. In the non-RM group, patients were supported with mechanical ventilation without RM. The variables of oxygenation index （PaO2/FiO2）, peak inspiration pressure （PIP）, plateau pressure （Pplat）, static pulmonary compliance （Cst） and EVLWI of patients in both groups were determined before treatment and 12 h,24 h, 48 h and 72 h after treatment, and were compared them between two groups. The hemodynamic changes were monitored before and after RM.One-way ANOVA, t -test and Fisher probabilities in 2/2 table were used to process the data. Results （ 1 ） The PaO2/FiO2 and Cst in two groups showed upward trend after treatment, but they were higher in RM group than those in non-RM group （ P 〈 0. 05 ）. The PIP and Pplat of two groups both had downward trend after treatment, but they were significantly lower in RM group than those in group non-RM （P 〈0.05）. （2） The EVLWI of two groups showed downward trend after treatment （ P 〈 0.05）, and the differences were significant at all intervals （F： 22.392, 8.147, P 〈 0.01）. The EVLWIs in group RM were lower than those in group non-RM at the intervals of 12 h,24 h, 48 h and 72 h separately （P 〈0.05 or P 〈 0.01）. （3） There were transient hemodynamic changes occurred during RM, and compared with pre-RM, the changes were significantly different （ P〈 0.01 ）. Compared with pre-RM, the hemodynanic changes were not significantly different 120 seconds after the end of RM （ P 〉 0.05）. Conclusions RM could reduce the EVLWI, increase oxygenation and lung compliance.The effect of RM on hemodynamics was transient.