肺复张和保护性通气治疗术后急性呼吸窘迫综合征的效果观察

Effect of lung recruitment maneuver and protective ventilation on postoperative acute respiratory distress syndrome

目的探讨早期肺复张联合保护性机械通气对手术后并发急性呼吸窘迫综合征(ARDS)患者的临床疗效。方法采用前瞻性随机对照法,选择早期并发中重度ARDS的患者为研究对象,分为标准治疗组和肺复张治疗组。入组患者转入ICU后,均给予原发病治疗,保护性通气策略,气道温湿化治疗。标准治疗组给予保护性机械通气治疗(PCV),潮气量(VT)≤6 mL/kg,调整吸入氧浓度(FiO 2)和呼气末正压(PEEP),维持气道平台压(Pplat)≤30 cmH 2 O;肺复张治疗组在保护性机械通气基础上联合间断肺复张治疗,每6 h肺复张1次,直至肺复张24 h或撤除呼吸机。比较两组患者治疗前后呼吸指标、血流动力学指标的变化,并记录两组预后及并发症发生情况。结果67例患者纳入分析,标准治疗组35例,肺复张治疗组32例。随机化入组后,与标准治疗组相比,肺复张组治疗0.5 h后PaO 2/FiO 2升高,呼吸系统顺应性有改善趋势,但无统计学差异,两组的FiO 2、PEEP水平有显著差异。6.5 h后,肺复张组的PaO 2/FiO 2显著升高,呼吸系统顺应性改善,FiO 2显著下降。与标准治疗组相比,肺复张组ICU住院时间、机械通气时间、人工气道拔除时间明显缩短。结论与标准治疗比较,肺复张联合保护性通气治疗手术后并发中重度ARDS患者,可改善肺顺应性,纠正低氧血症,缩短机械通气时间及ICU住院时间,促进患者康复。

Objective To investigate the clinical effect of early lung recruitment maneuver combined with protective mechanical ventilation on patients with acute respiratory distress syndrome(ARDS)after operation.Methods A prospective randomized controlled study was designed to select the patients with severe ARDS in early stage.The patients with early severe ARDS were divided into the standard treatment group and the lung recruitment therapy group.The patients were transferred to ICU,and given the treatment of primary disease,protective ventilation strategy and airway humidification therapy.The standard treatment group was treated with protective mechanical ventilation(PCV),the tidal volume(VT)was less than 6 mL/kg,the inhalation oxygen concentration(FiO 2)and the positive end expiratory pressure(PEEP)were adjusted,and the airway plateau pressure(Pplat)was less than 30 cmH 2 O.The lung recruitment therapy group was combined with intermittent lung recruitment on the basis of protective mechanical ventilation,the lungs were recruited once every 6 hours until 24 hours after recruitment or the ventilator was withdrawn.The changes of respiratory and hemodynamic indexes were compared between the two groups before and after treatment,and the prognosis and complications were recorded.Results 67 patients were included in the analysis,including 35 in the standard treatment group and 32 in the lung recruitment therapy group.After being randomized into the group,compared with the standard treatment group,PaO 2/FiO 2 of the lung recruitment therapy group increased after 0.5 h of treatment,and the respiratory system compliance showed an improvement trend,but there was no statistical difference.The levels of FiO 2 and PEEP in the two groups were significantly different.After 6.5 h,PaO 2/FiO 2 of the lung recruitment therapy group was significantly increased,respiratory compliance was improved,and FiO 2 was significantly decreased.Compared with the standard treatment group,ICU hospitalization time,mechanical ventilation time and artificial airway extraction timeof the lung recruitment therapy group were significantly shortened.Conclusion Compared with the standard treatment,lung recruitment combined with protective ventilation given to the patients with moderate to severe ARDS can improve the lung compliance and correct hypoxemia,shortening the mechanical ventilation time and the time of hospitalization of ICU,promoting the recovery of the patients.