胸腔积液引流对ARDS机械通气患者氧合及呼吸力学的影响

Effects of pleural effusion drainage on oxygenation and respiratory mechanics in ARDS patients with mechanical ventilation

目的观察胸腔积液引流对机械通气的急性呼吸窘迫综合征(ARDS)患者氧合及呼吸力学的影响。方法选择2013年1月至2014年6月的在河南中医学院第一附属医院重症医学科住院的43例机械通气合并大量胸腔积液(≥500 ml)的ARDS患者,其中肺内源性组25例,肺外源性组18例。在超声引导下行胸腔积液引流术,术前及术后记录两组患者的氧合指数(Pa O2/Fi O2)、肺静态顺应性(Cstat)、平台压(Pplat)、气道峰压(Ppeak)。结果两组患者在胸腔积液引流术后呼吸力学参数改善,Cstat均高于术前(P均<0.05),而Pplat、Ppeak均低于术前(P均<0.05)。肺内源性组在胸腔积液引流术前后Pa O2/Fi O2变化无统计学差异(P>0.05),肺外源性组在胸腔积液引流术后Pa O2/Fi O2高于术前(P<0.05)。结论胸腔积液引流可改善机械通气合并大量胸腔积液ARDS患者的呼吸力学指标及肺外源性ARDS患者的氧合,但不改善肺内源性ARDS患者的氧合。

Objective To observe the effects of pleural effusion drainage on oxygenation and respiratory mechanics in a- cute respiratory distress syndrome （ARDS） patients with mechanical ventilation. Methods Forty-three ARDS patients with a large number of pleural effusion （ ≥500 ml） and received mechanical ventilation in our department between January 2013 and June 2014 were enrolled in this study. Out of the 43 patients,25 were pulmonary ARDS （puhnonary group）, 18 were extra-pulmonary ARDS （extra-pulmonary group）. The ultrasound-guided drainage of pleural fluid was conducted in all patients, and the oxygenation index （ PaO2/FiO2 ）, hmg static compliance （ Cstat）, plateau pressure （ Pplat ） and airway peak pressure（Ppeak） before and after drainage were recorded. Results Respiratory mechanics were significantly im- proved after drainage with the increase of Cstat （ all P 〈 0.05 ） and the decreases of Pplat and Ppeak （ all P 〈 0.05 ） in both pulmonary and extra-plmnonary groups. After drainage, the PaO2/FiO2 ratio in pulmonary group remained unchanged （ P 〉 0.05 ）, but increased in extra-pulmonary ARDS group （ P 〈 0.05 ）. Conclusions For ARDS patients with a large nmnber of p]eural effusion and received mechanical ventilation, the drainage of pleural effusion can improve respiratory mechanics of both pulmonary and extra-pulmonary ARDS patients and oxygenation of extra-pulmonary ARDS patients, but cannot improve oxygenation of pulmonary ARDS patients.