氧合指数与肺静态顺应性对急性肺损伤机械通气的判定价值

Clinic value of oxygenation index and standing compliance during treating acute lung injury with mechanical ventilation

目的 对14例ALI患者采用低潮气量加呼气末正压(PEEP)通气的患者行氧合指数(PaO2/FiO2)和肺静态顺应性(Cst)监测,了解此判定标准的临床意义。方法 最初采用A/C通气(VT8ml/kgfl6次/minflow34L/min),并逐渐增加PEEP(5、10、15、20cmH2O),每种方式30分钟,4种方式FiO2不变。利用Swan-Ganz导管获得血液动力学和氧代谢参数。结果 PaO2/FiO2随着PEEP的增高而增加,Cst在PEEP10～15cmH2O时,可稳定在336±83ml/cmH2O水平,当进一步增加时,Cst和DO2也进一步下降,PIP增加。结论 对ALI采用低潮气量加呼气末正压通气的患者,监测PaO2/FiO2和Cst有助于最佳PEEP的选择和获得最大的DO2。

Objective To explore the clinic value of oxygenation index(PO 2/FiO 2) and standing compliance (Cst) by placing 14 patient of acute lung injury (AI) on low tidal volume with positive end -expiratory pressure (PEEP) and mirroring PO 2/FiO 2 and Cst .Methods Patient were optimally ventilated an A/C(V T8 ml/kg f 16/min flow 34L/min),gradually patients were on A/C+PEEP(5、10、15、20 cmH 20)for 30 min each .The FiO 2 was kept constant on four modes .Hemodynamics and oxygen metabolism parameters were obtained by using Swan-Ganz cather Results The PaO 2/FiO 2 progressive increase observed going from PEEP 5 to 20 cmH 2O. Cst was kept in 33 6±8 3 ml/cmH 2O(PEEP 10～15 cmH 2O).The Cst and DO 2 were down gradually (PEEP>15cmH 2O). The peak inspiratory pressure (PIP) was increased ( P <0 05).Conclusion Mirroring PaO 2/FiO 2 and Cst was beneficial to choose the best PEEP and obtain the largest DO 2 during ALI with mechanical ventilation [