肺复张策略对防止纤支镜治疗后肺泡塌陷的作用观察

Clincal observation of lung recruitment strategy in prevention of alveolar collapse after bronchoscopy

目的:探讨肺复张策略对防止纤支镜治疗后肺泡塌陷的效果。方法:将机械通气需纤维支气管镜检查的60例患者随机分为治疗组及对照组,治疗组采用肺复张策略,对照组行常规机械通气。比较2组动脉血气和氧代谢、血流动力学指标。结果:治疗组纤维支气管镜检查前PaO2(114.25±24.75)mmHg,PaCO2(32.56±7.73)mmHg,肺复张30 min后PaO2(112.12±20.41)mmHg,PaCO2(31.56±6.63)mmHg,PaO2及PaCO2肺复张前后无明显差异(均P>0.05);对照组纤维支气管镜检查前PaO2(116.11±26.53)mmHg,PaCO2(30.12±5.53)mmHg,常规机械通气30 min后PaO2(86.21±16.23)mmHg,PaCO2(31.56±6.63)mmHg,常规机械通气治疗前后PaO2有显著性差异(P<0.01),而PaCO2无明显差异(P>0.05)。结论:支气管镜检查后采用肺复张策略能复张塌陷的肺泡,减少低氧血症对机体的危害,并对血流动力学影响较小。

Objective： To investigate the efficacy of lung recruitment strategy in prevention of alveolar collapse in pa- tients after fibrobronchoscopie treatment. Methods： Sixty patients with mechanical ventilation required bronehoseopic treat- ment were randomly divided into treatment group （ lung recruitment group ） and control group （ conventional mechanical ventilation group）. The arterial blood gas, parameters of anaerobic metabolism and hemodynamic index were compared be- tween the two groups. Results ： PaO2 was （ 114.25 ± 24.75） mmHg and PaCO2 was （32.56 ± 7.73 ） mmHg before treat- ment in treatment group, while PaO2 was （112.12 ± 20.41 ） mmHg and PaCO2 was （31.56 ± 6.63 ） mmHg 30 minutes af- ter lung recruitment. There was no significant differences at the level of PaO2 and PaCO2 before and after lung recruitment （P 〉 0.05 ）. PaO2 was （116.11 ± 26.53 ） mmHg and PaCO2 was （30.12 ± 5.53 ） mmHg in control group before fibro- bronehoscopy. After 30 minutes＇ general mechanical ventilation, PaO2 was （86. 21 ± 16. 23 ） mmHg and PaCO2 was （31.56 ± 6.63 ） mmHg in control group. The level of PaO2 after conventional mechanical ventilation was lower than that before conventional mechanical ventilation （ P 〈 0.01 ） , but there was no significant differences at level of PaCO2 （ P 〉 0.05 ）. Conclusions ： Through lung recruitment strategy we can reexpanse the collapsed alveolars, attenuate the harm of hy- poxemia, and almost not influence hemodynamic.