呼气末正压通气在肺灌洗中的选择和应用

The Selection and Application of PEEP in Whole Lung Lavage

目的探讨呼气末正压(PEEP)通气在肺灌洗中的选择和应用。方法选择14例行全肺灌洗术的肺泡蛋白沉积症患者。随机分为实验组和对照组,各7例,实验组根据每个患者灌洗肺通气时的压力-容积曲线(P-V曲线)中吸气支的低拐点来确定PEEP值;对照组选择PEEP 5cmH2O通气。观察患者在使用PEEP前、PEEP通气30min、使用PEEP后的心率(HR)、有创平均动脉压(MAP)、中心静脉压(CVP)、心搏出量(CO)、每搏量(SV)、外周血管阻力指数(SVRI)、胸液成分(TFC)、心肌加速度指数(ACI)、呼气末二氧化碳(PetCO2)、气道峰压(Peak)、气道平台压(Plat)、动态肺顺应性、气道阻力以及血气分析值的变化。结果对照组各观察值在PEEP通气前后变化无统计学意义(P>0.05);在PEEP通气时,实验组的MAP降低、CVP和SPO2增高、TFC增高、PetCO2降低、Plat增高(P<0.05)。与PEEP通气前比较,实验组在PEEP通气后的PaCO2降低、SaO2增高(P<0.05)。与对照组比较,实验组在PEEP通气时的MAP降低、CVP、SPO2、PetCO2增高(P<0.05)。结论根据P-V曲线中吸气支的低拐点来确定PEEP值能使肺灌洗患者术中改善氧合。

Objective To observe the selection and application of end-expiratory pressure（PEEP） in whole lung lavage.Methods 14 patients of pulmonary alveolar proteinosis were divided into two groups.Were randomly divided into experimental group and control group,7 cases in each.Experimental group：determined the PEEP according to the low inflection point in pressure-volume curve（P-V curve）;control group：5cmH2O of PEEP.Patients were observed the changes of HR,MAP,CVP,CO,SV,SVRI,TFC,ACI,and PetCO2,Peak,Plat,lung compliance,airway rsistance and blood gas analysis values before the use of PEEP,PEEP ventilation for 30min,and after PEEP ventilation.Results Hemodynamics and respiratory mechanics of controlled group has no significant（P0.05）.In experimental group,MAP and PetCO2 decreased;CVP,SPO2 and TFC,Plat increased in PEEP ventilation for 30min（P0.05）.When compared with controlled group,the experimental group′s MAP decreased,CVP and SPO2,PetCO2 increased（P0.05）.Conclusion The determination of PEEP value based on the inspiratory branch low inflection point on the pressure-volume curve（P-V curve） improve lavage patients′ oxygenation.