不同呼气末正压对ARDS患者血管外肺水的影响

Effect of different end-expiratory pressure levels on extravascular lung water in patients with acute respiratory distress syndrome

目的探讨在ARDS患者中给予不同呼气末正压水平对于患者血管外肺水的影响差异。方法收集35例呼吸窘迫综合征患者,随机分为A、B两组,A组共17例患者,给予呼气末正压8cm H2O治疗,B组共18例患者,给予呼气末正压12cm H2O治疗,监测并比较两组患者在即刻、6、12、24 h四个时间点的EVLWI、CI、CVP、MAP、HR数值。结果插管即刻两组的各项观察指标进行比较差异无统计学意义(P>0.05)。与治疗前比较,治疗后A、B两组的EVLWI的数值均较低,两组的△EVLWI在12 h比较差异有统计学意义(P<0.05);在24 h时比较差异具有高度统计学意义(P<0.01),其他的观察指标间差异无统计学意义(P>0.05)。结论在急性呼吸窘迫综合征患者中给予不同呼气末正压水平(8cm H2O、12cm H2O),对EVLWI的影响有显著性,尤其是对于其12 h和24 h的影响较为显著,对于其他的指标影响不明显。

Objective To investigate the acute respiratory distress syndrome in patients given different PEEP levels for patients with extravascular lung water differences. Methods All of 35 cases of respiratory distress syndrome were randomly divided into A, B groups. A group of 17 patients, received end-expiratory pressure 8cm H2O treatment , B group of 18 patients were given PEEP 12cm H：O treatment. We monitored and compared two groups EVLWI, CI, CVP, MAP, HR values in the immediate, 6,12,24 hour time points. Results The observation indicators at immediate intubation between two groups were compared no significant difference （P 〉 0.05）. Compared with before treatment, after treatment A, B groups of EVLWI were lower, AEVLWI of two groups in 12 hours compared with a significant difference （P 〈 0.05）; At 24h, with the difference statistically significant significance （P 〈 0.01）, There were no significant difference in other indicators between two groups （P 〉 0.05）. Conclusion In patients with acute respiratory distress syndrome given different levels of PEEP （8cmH2O, 12cmH2O）, the impact on EVLW significantly, especially for its 12 hours and 24 hours of impact is more significant, for the other indicators of impact is unknown.