肺复张策略在有创通气患者行纤维支气管镜治疗后的对比研究

Comparative Study of Recruitment Maneuver in Mechanically Ventilated Patients after Fibrobronchoscopy

目的研究在气道分泌物较多或吸入异物的有创通气患者中,行纤维支气管镜治疗后应用肺复张策略的治疗效果。方法 2012年9月-2014年7月抽样选取200例气道分泌物较多或吸入异物的有创通气患者,随机分成治疗组(n=100)和对照组(n=100),两组患者均行纤维支气管镜清理呼吸道治疗,其中治疗组进行肺复张策略,观察两组患者治疗前、治疗后2 h氧合指数、动脉血二氧化碳分压(Pa CO2)、心率、气道阻力、肺动态顺应性(Cdyn)变化及有创通气时间和住重症监护病房(ICU)时间。结果治疗后,治疗组和对照组氧合指数分别为(291.14±38.49)、(241.39±35.62)mm Hg(1 mm Hg=0.133 k Pa),Pa CO2分别为(41.65±7.73)、(38.87±7.97)mm Hg,Cdyn分别为(48.94±11.21)、(39.59±10.98)m L/cm H2O(1 cm H2O=0.098 k Pa),均较治疗前升高(P<0.05);治疗组和对照组心率分别为(95.41±20.59)、(106.47±19.11)次/min,气道阻力分别为(17.87±8.32)、(23.98±7.88)cm H2O/(L·s),均较治疗前降低(P<0.01)。治疗组有创通气时间为(15.72±6.42)d,住ICU时间为(19.85±8.12)d,对照组有创通气时间为(20.49±7.21)d,住ICU时间为(27.87±10.33)d。与对照组治疗后比较,治疗组治疗后患者的气道阻力降低、有创通气时间和住ICU时间减少,Cdyn、氧合指数和Pa CO2均升高(P<0.01);心率改变组间差异无统计学意义(P>0.05)。结论在气道分泌物较多或吸入异物的有创通气患者中,行纤维支气管镜治疗后应用肺复张策略,使患者萎陷的肺泡能够再次复张,能显著改善患者肺通气和换气功能障碍,增加了肺的顺应性,提高肺弥散功能,从而缩短有创通气时间和住ICU时间,对患者的治疗有重要意义。

Objective To investigate the effect of recruitment maneuver（RM） following fibrobronchoscopy in invasively mechanically ventilated（IMV） patients with excessive airway secretions or foreign body aspiration.Methods From September 2012 to July 2014,200 eligible patients were randomly assigned to intervention group（n=100） and control group（n=100）.Airway clearance by fibrobronchoscopy was conducted in both the two groups,but RM was subsequently performed only in the intervention group.Outcome measurements included oxygenation index,partial pressure of carbon dioxide（PaCO2）,heart rate（HR）,air way resistance（Raw） and dynamic lung compliance（Cdyn）before and 2 hours after treatment,and duration of IMV and Intensive Care Unit（ICU） stay were also analyzed.Results After treatment with fibrobronchoscopy,oxygenation index[intervention vs.control：（291.14±38.49） vs.（241.39±35.62） mm Hg（1 mm Hg=0.133 kPa）],PaCO2[（41.65±7.73） vs.（38.87±7.97） mm Hg]and Cdyn[（48.94±11.21） vs.（39.59±10.98） mL/cm H2O（1 cm H2O=0.098 kPa）]were significantly increased,while HR[（95.41±20.59）,vs.（106.47±19.11）beats/min]and Raw[（17.87±8.32） vs.（23.98±7.88） cm H2O/（L · s）]were significantly decreased in both groups（P〈0.01）.Duration of IMV and ICU stay in the intervention group were（15.72±6.42） and（19.85±8.12） days respectively,while in the control group were（20.49±7.21） and（27.87±10.33） days.Compared with the control group,patients in the intervention group had lower Raw,duration of IMV and ICU stay,and higher Cdyn,oxygenation index,and PaCO2（P〈0.01）,but no significant difference was found in HR（P〉0.05）.Conclusion In mechanically ventilated patients with excessive airway secretion or foreign body aspiration,recruitment maneuver following fibrobronchoscopy is of great clinical importance,due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli,improving pulmonary ventilation and gas exchange,lung compliance and diffusion capacity.