肺开放策略治疗急性呼吸窘迫综合征的临床研究

Clinical Study of Recruitment Maneuvers in Acute Respiratory Distress Sydrome

目的探讨压力控制法进行肺开放治疗急性呼吸窘迫综合征(ARDS)的临床疗效。方法 52例ARDS患者在肺保护通气的基础上采用压力控制法进行肺开放,将呼吸机调整到压力支持模式,个体化使用PEEP和支持压力水平,PEEP15～25 cm H2O,支持压力15～20 cm H2O,气道峰压不超过45 cm H2O,维持1分钟,肺开放后继续进行肺保护通气。动态观察肺开放策略实施前后氧合指标、呼吸力学指标及血流动力学指标的变化。结果 52例ARDS患者共进行164次肺开放,肺开放前后氧合功能障碍明显改善。结论肺开放策略治疗重症ARDS明显改善了肺的氧合功能和顺应性,对血流动力学影响小,相对安全,有效地提高了抢救成功率。

Objective To research effects of recruitment maneuvers（RM） in acute respiratory distress syndrome（ARDS）.Methods 52 patients with severe ARDS underwent RM with lung-protected treatment.Pressure support method were used;PEEP and pressure level were adjusted individually：PEEP 15～25 cm H2O,support pressure 15～20 cm H2O,peak pressure did not exceed 45 cm H2O,process maintained 1 min.Lung-protected ventilation were continued after RM.Oxygenation,respiration dynamo,hemodynamics index were recorded before and after RM and then analyzed.Results 52 patients underwent RM 164 times in total,oxygenation function was obviously improved after RM.Conclusions Recruitment maneuvers on severe ARDS would improve oxygenation and lung compliance and had few side effects on hemodynamics.It is safely to use and can increase successful rate of rescue.