叹气法肺复张对肺外源性和肺内源性急性呼吸窘迫综合征疗效的影响

Effects of sigh in patients with acute respiratory distress syndrome caused by extrapulmonary and pulmonary disease

目的对比研究叹气法肺复张对肺外源性和内源性急性呼吸窘迫综合征(ARDS)的治疗效果及对血流动力学的影响。方法选择2006年11月至2008年11月河北省人民医院重症医学科收治的ARDS患者30例,分肺外源性ARDS组(ARD-Sexp组)和肺内源性ARDS组(ARDSp组)。在小潮气量通气及适宜的呼气末正压基础上,行叹气法肺复张。结果与基础期比较,两组患者在叹气期30、60min的氧合状态明显改善,动脉血氧分压与吸入氧浓度之比(PaO2/FiO2)明显升高(P<0.05),ARDSexp组升高更为明显(P<0.05);与基础期比较,两组患者在叹气期60min时静态顺应性明显提高(P<0.05);在整个研究过程中,两组患者心率(HR)、平均动脉压(MAP)及中心静脉压(CVP)无明显变化(P>0.05);两组患者均未发生胸、纵隔及皮下气肿等并发症。结论持续的叹气能明显改善患者的氧合状态及胸肺顺应性,同时安全、易行,对于肺外源性ARDS治疗效果更明显。

Objective To assess the effects of sighs with low tidal volume（VT） ventilation on improving gas oxygenation and respiratory mechanics in patients suffering from acute respiratory distress syndrome（ARDS）, and to assess the effects of sighs on hemodynamics. Methods Thirty patients with ARDS （ARDSexp group,ARDSp group）admitted from November 2006 to November 2008 in ICU of Hebei provincial peoplers hospital were enrolled in the study. We provided the kind of mechanical ventilation that is small VT and a suitable PEEP with sighs. Results Compared with baselines, PaO2/FiO2 was significantly increased in the two groups in sigh period（P^0.05） ,and ARDSexp group was higher then ARDSp group（P%0.05）, static compliance（Cstat） increased markedly after sigh in the two groups（P%0.05）. There were no significant differences between baselines and sigh period for hemo- dyna micsrheart rate （HR） ,mean arterial pressure（MAP） and central venous pressure（CVP）]. Barotrauma did not occur in all patients. Conclusion Persistent sigh significantly improve oxygenation and compliance of respiratory system. Persistent sigh is safe and simple. This study also suggests that patients with ARDS caused by extrapulmonary disease respond better to sigh than ARDS caused by pulmonary disease.