肺复张对肺外源性ARDS患者肺顺应性及血流动力学的影响

Effect of recruitment maneuver on lung compliance and hemodynamics in patients with extrapulmonary

目的探讨肺复张对肺外源性急性呼吸窘迫综合征(ARDS)患者的肺顺应性及血流动力学的影响。方法将56例肺外源性ARDS患者随机分为观察组(30例)和对照组(26例),对照组采用小潮气量和最佳PEEP的保护性机械通气治疗,观察组在对照组治疗基础上行肺复张治疗,比较两组患者治疗前后呼吸力学和血流动力学指标的变化。 结果经治疗72h后两组患者的HR、PaO2/FiO2及APACHEⅡ评分均明显改善,且观察组的改善情况优于对照组(P<0.05);经治疗72h后观察组的Pplat、Raw低于对照组(P<0.05),而观察组的Cstat高于对照组(P<0.05);两组的CVP、SVRI、SVI及LVEF均较治疗前有明显改善(P<0.05),且观察组的SVI、LVEF及SVRI均高于对照组(P<0.05)。结论肺复张联合保护通气策略的治疗措施能改善肺外源性ARDS患者的肺顺应性,稳定血流动力学。

Objective To investigate the effect of recruitment maneuver(RM) on lung compliance and hemodynamics in patients with extrapulmonary ARDS. Methods 56 patients with extrapulmonary ARDS were randomly divided into observation group (30 cases) and control group (26 cases). The control group was treated with small tidal volume and the best PEEP protective mechanical ventilation. The observation group was treated with RM therapy on the basis of the control group. The changes of respiratory mechanics parameters and hemodynamic parameters were compared between the two groups before and after treatment. Results After treatment, the scores of HR, PaO2/FiO2 and APACHEⅡ of the two groups were significantly improved, and the improvement in the observation group was better than that of the control group (P<0.05). After treatment, the Pplat and Raw of the observation group were lower than those of the control group (P<0.05), and Cstat was higher than that of the control group (P<0.05). The CVP, SVRI, SVI and LVEF of the two groups were all improved compared with those before treatment (P<0.05), and the SVI, LVEF and SVRI of the observation group were higher than those of the control group (P<0.05). Conclusion RM combined with small tidal volume protective ventilation can improve lung compliance and stabilize hemodynamics of extrapulmonary ARDS patients.