无创通气条件下肺复张在早期ARDS的应用分析

Lung recruitmen application analysis in conditions of noninvasive ventilation for the early ARDS

目的评价对早期急性呼吸窘迫综合征(ARDS)患者进行肺复张(RM)的疗效和安全性。方法对30例早期ARDS患者应用大型多功能呼吸机Puritan-bennett 840经面罩连接行无创机械通气。在无创通气基础上,采用CPAP法进行肺复张,动态观察复张前后动脉血氧分压、氧合指数(PO2/FiO2)、动脉二氧化碳分压、pH值、心率、平均动脉压(MAP)、血压(BP)等治疗效果。结果肺复张前PaO2 70.1±11.55 mmHg,PaO2/FiO2 163.00±33.56 mmHg;肺复张后30min PaO2 106.37±21.17mmHg,PaO2/FiO2 218.34±40.01 mmHg。肺复张后1h PaO2 90.76±11.40mmHg,PaO2/FiO2203.25±30.77 mmHg肺复张后30min及1h动脉血氧分压和氧合指数明显升高,复张前后比较具有显著性差异(P<0.05)。动脉二氧化碳分压、pH值在复张前后各时间段没有明显差异(P>0.05)。血流动力学指标如心率、平均动脉压、血压等在复张前后各时间段没有明显差异(P>0.05)。结论对于早期ARDS患者,应用无创通气进行肺复张短时间内可提高动脉血氧分压和氧合指数;肺复张前后呼吸、血流动力学指标稳定。无创通气肺复张治疗早期ARDS安全有效。大型多功能呼吸机替代传统无创呼吸机进行无创通气能够提供较高的压力,具有更完善监测功能,使肺复张更加充分完全。

Objective To evaluate early acute respiratory distress syndrome（ARDS） patients with lung recruitment（RM） efficacy and safety.Methods 30 cases of patients with early ARDS multifunctional application breathing machines Puritan-Bennett 840 the mask noninvasive mechanical ventilation connection line.Noninvasive ventilation in based on the method,The method of complex CPAP lung recruitment,dynamic observation after a blood oxygen partial pressure and oxygen before and after oxygen index（PO2/FiO2）,artery pressure,pH value carbon dioxide points,the heart rate,mean arterial pressure（MAP）,blood pressure（BP）,and other therapeutic effect.Results After a former lung recruitment PaO270.1±11.55mmHg,PaO2/FiO2 163.00±33.56mmHg;Lung recruitment after 30 min PaO2 pictures 106.37±21.17 mmHg,PaO2/FiO2 218.34±40.01mmHg.Lung recruitment after 1h PaO2 90.76±11.40mmHg,PaO2/FiO2 203.25±30.77 mmHg lung recruitment after 30 min and 1 h arterial oxygen partial pressure and oxygen and index increased significantly,after lung recruitment compared before significant difference（P0.05）.Artery pressure,pH value carbon dioxide points in after a period before and after each no significant difference（P0.05）.Hemodynamic parameters such as heart rate,mean arterial pressure,and blood pressure in complex before and after each time a no significant difference（P0.05）.Conclusion For the patients with early ARDS noninvasive ventilation,application for lung recruitment a short time can improve blood oxygen partial pressure and oxygen index.