肺复张操作对静水压增高型肺水肿血管外肺水的影响

Effects of lung recruitment maneuver on extravascular lung water index in patients with hydrostatic pressure pulmonary edema

目的探讨肺复张操作（RM）对静水压增高型肺水肿血管外肺水的影响。方法选择肺血管通透性指数（PVPI）正常，血管外肺水指数（EVLWI）≥10ml／kg患者39例，根据是否行RM分为RM组（21例）和对照组（18例）。记录RM组RM前（T0）、RM后O（T1）、1（T2）、2（T3）、3（T4）、6（T5）、12（T6）、24h（T7）的EVLWI、全心舒张末期容积指数（GEDVI）、心指数（Cl）、肺顺应性（Cdyn）、氧合指数（PO2／FiO2）、氧输送（DO2）、氧消耗（VO2）、肺泡-动脉氧分压差（PA-aO2）、液体出入量，机械通气时间及ICU住院时间，并与对照组进行比较。结果RM组EVLWI和GEDVI在T1～T4低于对照组，PO2/FiO2在T1～T5大于对照组，Cdyn在T1～T4大于对照组，PA-aO2在T1～T2大于对照组，差异均有统计学意义（均P〈005）；RM组EVLWI在T0～T3差异无统计学意义（P〉0．05），在T1～T5差异有统计学意义（P〈0．05）；两组DO2、VO2、机械通气时间及ICU住院时间的差异均无统计学意义（均P〉005）；EVLWI与GEDVI、PO2/FiO2、PA-aO2、Cdyn存在相关性（均P〈0.05）。结论RM能一过性降低静水压型肺水肿患者的EVLWI水平，改善氧合及Cdyn，但不影响DO2、VO20RM不能缩短机械通气时间及ICU住院时间。

Objective To investigate the effects of lung recruitment maneuver （RM） on extravascular lung water index in patients with hydrostatic pressure pulmonary edema. Methods Thirty nine patients with hydrostatic pressure pulmonary edema and normal pulmonary vascular permeability index （PVPI） and extravascular lung water index （EVLWl） ≥ 10ml/kg were enrolled in the study. Among them, 21 patients received RM （RM group） and RM was not executed in other 18 patients （control group）. In the RM group, the EVLW1, global end-diastolic volume index（GEDVl）, cardiac index（CI）, oxygenation index（POJFiO2）, dynamic lung compfiance（Cdyn）, oxygen delivery（DO2）, oxygen consumption（VO2）, alveolo-arterial oxygen partial pressure difference （PA-aO2）, liquid intake（To） and output volume at 0（T1）,1（T2）, 2（T3）, 3（T4）, 6（T5）,12（T6） and 24h（TT） after RM, and length of intensive care unit stay and mechanical ventilation were documented and compared with control group. Results EVLWl and GEDVl in RM group were lower than those in control group at T1-T4. POJFiO2 was higher than that in control group at T1-T5. Cdyn was higher than that in control group at T1-T4, PA-a O2 higher than that in control group at T1-T2 （P〈0.05）. There was no significant difference in EVLWl in RM group at T1-T3 and there was significant difference at T1-T5. There were no significant differences in DO2, VO2, length of intensive care unit stay and mechanical ventilation between RM and control groups（P ：〉0.05）. GEDVl, PO2/FiO2, PA-,O2 and Cdyn levels were correlated with EVLWl （all P〈0.05）. Conclusion RM can reduce the level of ELVWl transiently in hydro- static pressure pulmonary edema and improve POJFiO2 and Cdyn, but can not affect DO2 and VOw, and shorten the length of intensive care unit stay and mechanical ventilation.