肺复张通气策略治疗急性呼吸窘迫综合征临床观察

A RESEARCH ABOUT VENTILATION STRATEGY USING RECRUITMENT MANEUVER FOR ACUTE LUNG INJURY/ACUTE RESPIRATORY DISTRESS SYNDROME

目的:寻找治疗急性呼吸窘迫综合征的最佳通气策略,对肺复张手法的安全性进行监测。方法:入选的ARDS病人均行气管插管,有创机械通气(呼吸机型号为PB840)。20例ARDS病人随机分为小潮气量组(对照组)和小潮气量+肺复张通气组(实验组)。每组10例。对照组在综合治疗基础上采取基础通气模式即:小潮气量(6mL/Kg)+个体化PEEP的通气模式。实验组联合肺泡复张治疗,其余同对照组。肺泡复张手法具体操作如下:镇静状态下将FiO2调至100%,持续5min,在非肌肉松弛状态下将呼吸机模式调整为持续气道正压(CPAP),给予30cmH2O的压力,持续30s后,恢复原通气模式及条件。比较两种通气策略下,病人的临床疗效、呼吸力学指标、血流动力学变化及安全性等方面的影响。结果:(1)治疗组氧分压、氧合指数、肺顺应性与对照组比较从开始30Min就有明显改善(P<0.01),24、48h也均维持在较高数值。(2)气道峰压、平台压与对照组相比明显下降(P<0.01)。(3)实施肺复张策略无明显血流动力学影响(P>0.05)。结论:以个体化PEEP为基础,适时采用肺复张通气策略治疗ARDS,与小潮气量通气策略相比更适合病人呼吸力学特征,改善顺应性、改善氧合、减少肺外器官损害,是肺保护性通气策略的重要补充。肺复张策略是ARDS病人机械通气时安全有效的通气方法,具有良好的临床应用价值。

Objective ：To find the best ventilation strategy for patients with acute respiratory dis- tress syndrome（ARDS） to improve oxygenation, To monitor the safety of lung recruitment maneuver. Methods：In clinical experiments, selected ARDS patients underwent endotracheal intubation, on the breathing machine（PB840）. 20cases of ARDS Patients were randomly divided into a small tidal volume group（ control group） and small tidal volume ventilation ＋ lung recruitment maneuver group （experi- mental group）. The control group take the small tidal volume（6mL/Kg） of the ventilation ＋ personally PEEP. the recruitment maneuver operation is as follows： before recruitment maneuver, take FiO2 to 100% ,continuous 5 rain,in a state of non -muscle relaxation breathing machine model will be adjus-ted to continuous positive airway pressure（CPAP） , to give 30cmH20 of pressure, continuous 30 s, then recover to the original ventilation mode and conditions. Comparison of two kinds of ventilation strategies on clinical efficacy and prognosis of patients with such implications. Results： 1, compared with the con- trol group, the P02, oxygenation index and cst of treatment group is significant improvement at 30min from start （P 〈 0.01 ）, also maintained at a higher value at 24h,48h. 2, PIP and Plate is significantly lower （ P 〈 0.01 ） than in the control group. 3, the implementation of lung recruitment maneuver does not increase the ventilator - associated lung injury. Conclusion： based on the personally PEEP, using of lung recruitment strategies of ventilation for treatment improve oxygenation, reduce non - pulmonary organ of ARDS is more suitable to improve compliance, damage than the small tidal volume ventilation strategy. It is an important supplement of the Lung protective ventilation strategy. It is a safe and effec- tive ventilation method in patients with ARDS, and to be a good clinical value.