无创正压通气对脓毒症所致急性肺损伤患者血流动力学的影响

Effects of noninvasive positive ventilation on hemodynamics in patients with acute lung injury induced by sepsis

目的研究无创正压通气(noninvasive positive ventilation,NIPPV)对脓毒症所致急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)早期患者血流动力学的影响。方法收集脓毒症所致ALI/ARDS共27例,观察通气前,通气后2～4 h、24 h及撤机后的动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、心率(HR),以及无创心功能所测平均动脉压(MAP)、心脏指数(CI)、心排血量(CO)、体循环血管阻力(SVR)等指数变化。结果经NIPPV治疗后,患者PaO2、SaO2较通气前显著增高(P<0.01),HR下降(P<0.05),MAP、CI、CO、SVR较通气前无显著改变(P>0.05)。结论 NIPPV能提高脓毒症所致ALI/ARDS早期患者的SaO2、PaO2,同时对血流动力学没有不良影响。

Objective To investigate the effects of noninvasive positive ventilation（NIPPV） on hemodynamics of patients with acute lung injury/acute respiratory distress（ALI/ARDS） induced by sepsis.Methods Twenty nine patients with ALI/ARDS induced by sepsis were included in the study.The blood gas analysis（SaO2,PaO2 and PaCO2）,HR,and hemodynamics（MAP,CI,CO,SVR） measured by noninvasive heart function before and 2-4 hours,24 hours after NIPPV,and withdrawing of NIPPV were recorded and analyzed.Results The index（PaO2,SaO2） were increased（P0.01）,HR was improved（P0.05）after treatment of NIPPV;while there were no significant differences in hemodynamics（MAP,CI,CO,SVR） before and after treatment（P0.05）.Conclusion For patients with ALI/ARDS induced by sepsis in the early stage,NIPPV treatment can improve the arterial oxygen saturation（SaO2） and arterial partial pressure of oxygen（PaO2）,and has no significant side effects on circulation dynamics.