呼吸末正压通气治疗急性肺损伤的临床研究

Clinical study of positive end-expiratory pressure ventilation in the treatment of acute lung injury

目的 :对急性肺损伤 (ALI)病人进行呼吸机辅助呼吸比较不同值的呼气末正压(PEEP)对ALI氧供及氧耗的影响及其副作用。方法 :14例确诊为ALI病人在同一呼吸机参数下(不同PEEP)选择PEEP 0、 5、 10、 15、 2 0cmH2 O条件下监测其血流动力学、肺力学以及氧供氧耗的变化。结果 :(1)随着PEEP的增加气道峰值压 (pip)随之增加 ,肺顺应性在PEEP 0～15cmH2 O时逐渐增加 ,当PEEP大于 15cmH2 O反而下降 ;(2 )PEEP在 0～ 15cmH2 O时心输出量(CO)变化不大 ,差异无显著性 (P >0 0 5 ) ,在PEEP大于 15cmH2 O时CO明显下降 ,差异有显著性 ,P <0 0 5 ;(3)PEEP在一定范围内增加 ,氧供及氧耗也随之增加 ,当PEEP大于 15cmH2 O时氧供及氧耗反而下降。结论 :ALI的呼吸机治疗过程中 ,PEEP在 10～ 15cmH2

Objective:To compare effect of variant positive end-expiratory pressure(PEEP)on oxygen delivery(DO 2) and oxygen consumption(VO 2) and their side effects by placing patient of acute lung injury(ALI) on ventilation.Methods:Hemodynamic,compliance of lung,DO 2 and VO 2 were monitored in 14 patients of ALI ventilated under the same ventilator and parameter and different PEEP (0,5,10,15,20cmH 2O).Results:(1)Peak inspiratory pressure(pip) increased according to PEEP,compliance of lung was increased according to PEEP ranged from 10 to 15cmH 2O,but it would decreased as PEEP was above 15cmH 2O.(2)Cardiac output(CO) had no marked change and had no statistical significance(P>0 05) asPEEP ranged from 0 to 15cmH 2O,but it would obviously decreased as PEEP was above 15cmH 2O.There was significantly higher(P<0 05).(3)DO 2 and VO 2 were also increased according to PEEP in a given scope,but they would decrease as PEEP was above 15cmH 2O.Conclusion:The largest DO 2 and the least side effect were obtained as PEEP ranged from 10 to 15cmH 2O during ventilative treatment for ALI.