利用压力-容量呼吸环对急性呼吸窘迫综合征不同类型肺通气障碍进行监测的临床研究

Clinical study on pressure-volume loop monitoring different types of pulmonary ventilatory dysfunction of acute respiratory distress syndrome

目的:研究急性呼吸窘迫综合征(ARDS)不同类型的肺通气障碍在呼吸波形的压力-容量呼吸环(PV呼吸环)上特征性改变及其临床意义。方法:按预后不同将24例严重ARDS患者分为治愈组(n=16)和死亡组(n=8)。监测其P-V呼吸环整体波形及P-V呼吸环的低拐点和高拐点压力变化情况,并寻找ARDS不同类型肺通气障碍在呼吸波形上的特征性改变。结果:ARDS可发生限制性和(或)阻塞性肺通气障碍;治愈组和死亡组P-V呼吸环的低拐点和高拐点在气道压力大小和波形特征上有显著的不同改变,其改变幅度和大小与ARDS严重程度呈正相关性。结论:根据ARDS病因不同可出现限制性、阻塞性、混合性通气障碍。利用呼吸波形P-V呼吸环对肺通气障碍进行监测,对ARDS肺通气障碍快速诊断和治疗效果评价有一定的临床指导意义。

Objective：To study the specific change and the clinical significance of the pressure-volume loop（PV loop）in the respiratory waveform of different types of pulmonary ventilatory dysfunction of acute respiratory distress syndrome（ARDS）.Method：Twenty-four severe ARDS patients were divided into healing group（n=16）and death group（n=8）according to different outcome.The different changes in the overall waveform of respiratory P-V loops were monitored.Study the pressure change of the lower and upper inflection points of respiratory PV loop,and search for characteristic changes in respiratory waveform of different types of pulmonary ventilatory dysfunction of ARDS.Result：Restrictive and/or obstructive ventilatory dysfunction could occur in ARDS.There was significant difference in airway pressure size and waveform characteristics of the lower and upper inflection points of respiratory P-V loop between healing and death groups.The magnitude and size related positively to the severity of ARDS.Conclusion：Restrictive ventilatory dysfunction,obstructive ventilatory disorder and mixed ventilatory disorder can occur according to the different causes of ARDS.The respiratory P-V loop of respiratory waveform could be used to monitor pulmonary ventilation dysfunction.It had important significance in rapid diagnosis and evaluating clinical therapeatic effects of ARDS pulmonary ventilation dysfunction.