肺保护通气对急性呼吸窘迫综合征患者的疗效及对右心功能的影响

Lung Protective Ventilation in Acute Respiratory Distress Syndrome and Its Impact upon Right Heart Function

【目的】探讨肺保护通气策略对ARDS患者的疗效及对右心功能的影响。【方法】选取2016年1月至2017年6月在我院重症医学科住院的ARDS患者共52例,年龄(48±7)岁。将所有患者随机分为对照组(24例)和肺保护组(28例),其中对照组采用潮气量8~15 m L/kg标准体质量,PEEP 4~8 cm H2O,平台压30~35 cm H2O;肺保护组采用潮气量6 m L/kg标准体质量,PEEP采用ARDSNET滴定法(PEEP-Fi O2表)进行设置,平台压<30cm H2O。收集患者不同通气时段Pa O2、PCO2、OI、乳酸、TAPSE、RVarea/LVarea、E/A、E/e、PASP、IVC等指标并进行统计分析。【结果】通气24 h肺保护组TAPSE、E/e高于对照组,PASP低于对照组(P<0.05);通气48 h肺保护组OI、Pa O2、PCO2、乳酸均高于对照组(P<0.05),肺保护组TAPSE高于对照组,PASP和IVC低于对照组(P<0.05)。肺保护组机械通气时间、总住院时间短于对照组(P<0.01)。【结论】肺保护通气策略在改善ARDS患者氧合方面明显比常规通气策略更有优势,且对右心功能的影响小。

【Objective】To analyze the effects of lung protective ventilation strategy on clinical outcome and right heart function of ARDS patients.【Methods】From January 2016 to June 2017,ICU patients fulfilling the consensus criteria for acute respiratory distress syndrome were included in the study. 52 patients,aged（48±7）years old,were randomly divided into control group（24 cases）and lung protection group（28 cases）. Control group was ventilated with a tidal volume of 8～15 m L/kg standard weight,PEEP 4～8 cm H2O,plateau pressure 30～35 cm H2O,while lung protection group with a tidal volume of 6 m L/kg predicted body weight,PEEP（positive end expiratory pressure）set by PEEP-FiO2 table,plateau pressure〈 30 cm H2O. The values of PaO2（arterial partial pressure of oxygen）,PCO2（arterial partial pressure of carbon dioxide）,OI（oxygenation index）,Lac（lactic acid）,TAPSE（tricuspid annular plane systolic excursion）,RVarea/LVarea（right ventricular end-diastolic area/left ventricular end-diastolic area）,E/A（peak mitral flow velocity of the early rapid filling wave/peak mitral flow velocity of the late rapid filling wave）,E/e（peak mitral flow velocity of the early rapid filling wave/early diastolic velocity of the tricuspid annulus）,PASP（pulmonary artery systolic pressure）and IVC（inferior vena cava）were collected and analyzed. 【Results】After 24 hours of ventilation,TAPSE and E/e of lung protection group were higher compared to the control group,and PASP was lower compared to the control group（all P〈0.05）.After 48 h of ventilation,OI,PaO2,PCO2 and Lac in the lung protective group were higher compared to the control group（all P〈 0.05）;TAPSE of the lung protection group was higher compared to the control group,PASP and IVC were lower compared to the control group（all P 〈0.05）. The mechanical ventilation time and hospitalization time of the lung protection group were shorter compared to the control group（all P〈 0.01）.【Conclusion】Compared with routine ventilation strategy,lung protective ventilation strategy shows more advantages in improving the oxygenation and reducing negative effect on the right heart function of ARDS patients.