肺复张在体外循环心脏术后早期急性肺损伤-急性呼吸窘迫综合征患者的疗效观察

Effects of recruitment maneuvers in patients suffering from acute lung injury-acute respiratory distress syndrome after cardiac surgery with cardiopulmonary bypass

目的观察肺复张对体外循环心脏术后早期急性肺损伤-急性呼吸窘迫综合症(ALI-ARDS)患者的疗效与可能出现的不良反应。方法对符合ALI-ARDS诊断标准并接受机械通气的心脏术后患者34例进行肺复张,在原有的呼气末正压(PEEP)水平基础上以5 cmH2O/2 min逐渐增加PEEP至20 cmH2O,维持2min,以5 cmH2O/2 min递减至肺复张前的PEEP水平。观察患者生命体征、氧合指数以及血流动力学变化。结果 34例患者在肺复张术后氧合均有明显改善(PaO2/FiO2从(108.6±36.6)升高至(173.3±64.8),P<0.05),血流动力学在治疗前后均无显著差异(P>0.05)。所有病例在PEEP升高至一定水平时均会出现一过性动脉压下降,降低PEEP水平后很快恢复;全部病例未发生气压伤或其他并发症。结论对心脏术后早期发生AL-I-ARDS患者,进行肺复张可以有效地改善肺氧合功能,同时对血流动力学影响较小。

【Objective】Observation the effects and probably adverse reaction of recruitment maneuvers in patients suffering from acute lung injury-acute respiratory distress syndrome after cardiac surgery with cardiopulmonary bypass.【Methods】We did recruitment maneuvers on thirty-four patients who were under cardiac surgery with CPB and took mechanical ventilation.All of patients were diagnosed as ALL-ARDS.We gradually added the PEEP,5 cmH2O/2 min,until the final PEEP got to 20 cmH2O and maintained 2 min.Then we gradually reduced the PEEP,5 cmH2O/2 min,until it got to the PEEP value before this procedure.In this procedure,we kept observing the basic life status,PaO2/FiO2,and hemodynamic status.【Results】Oxygenation got better after recruitment maneuvers of all the thirty-four patients,and there was no statistically hemodynamic changes before and after the procedure.The blood pressure went down temporarily when the PEEP increased.When the PEEP got decreased,the blood pressure would get normal.There was no adverse reaction in all of patients.【Conclusion】Recruitment maneuvers is helpful to improve oxygenation for the patients suffering from acute lung injury-acute respiratory distress syndrome after cardiac surgery with cardiopulmonary bypass,and impact little on the hemodynamics.