肺保护性机械通气联合早期压力控制性肺复张对肺外源性急性呼吸窘迫综合征患者的影响

Effect of lung protective mechanical ventilation combined with early pulmonary pressure control re-expansion on patients with exogenous acute respiratory distress syndrome

目的观察肺保护性机械通气联合早期压力控制性肺复张对肺外源性急性呼吸窘迫综合征(ARD-Sexp)患者的影响。方法 2009年1月—2011年3月收治各种因肺外源性病因引起的急性呼吸窘迫综合征(ARDS)患者30例,均需机械通气。记录肺复张前及每次肺复张后30 min的呼气未正压(PEEP)、吸氧浓度(FiO_2);监测静态肺顺应性(CLS)及动脉血气,并记录并发症。结果肺复张后第1个24h平均PaO_2、氧和指数(PaO_2/FiO_2)较复张前显著升高(P<0.05),第2个24 h进一步升高(P<0.05),但平均pH值及PaCO_2无显著变化(P>0.05);第3个24h上述指标较第2个24h无明显升高(P>0.05)。肺复张后第1个24h平均FiO_2、平台压下降及CLS上升较复张前变化明显(P<0.05),第2个24 h进一步改善(P<0.05);肺复张后第3个24h平均FiO_2、平台压及CLS较第2个24h略有改变,但差异无统计学意义(P>0.05)。第1、2、3个24h不良事件呈增多趋势。结论肺保护性机械通气联合早期压力控制性肺复张对ARDSexp患者具有有利影响,但随着时间推移亦增加不良反应的发生。

Objective To observe the effect of lung protective mechanical ventilation combined with pressure control early lung recruitment on exogenous pulmonary acute respiratory distress syndrome（ARDSexp）.Methods From January 2009 to March 2011,due to varietv of exogenous etiology of acute respiratory distress syndrome（ARDS）,30 patients received mechanical ventilation.Before and 30 min after lung re-expansion,PEEP,oxygen concentration（FiO_2 ） were recorded,static lung compliance（CLS） and arterial blood gas were monitored,and recorded complications.Results After lung re-expansion, the 1st 24h average PaO_2,oxygen and index（PaO_2/FiO_2 ） were significantly higher than before re-expansion（P0.05）,the 2nd 24h these indexes further increased（P0.05）,but the average pH and PaCO_2 did not change significantly（P0.05）;the 3rd 24h these indicators were not increased obviously compared with the 2nd 24h（P0.05）,after the 1st 24h of lung re-expansion,average FiO_2,plateau pressure decreased and CLS increased more obviously than those before re-expansion （P0.05）,the 2nd 24h these indexes further improved（P0.05 ）;3rd 24h after lung re-expansion,average FiO_2,plateau pressure and CLS slightly higher than the 2nd 24h,but the difference was not statistically significant（P0.05）.1st,2nd, 3rd 24h the bad event with trendy of increase.Conclusion Lung protective mechanical ventilation combined with pressure control early lung recruitment in patients with ARDS of extra-pulmonary origin has a positive beneficial effect,but gradually the adverse reactions were increased.