跨肺压滴定呼气末正压对急性呼吸窘迫综合征呼吸力学影响的临床研究

Clinical study on the effect of PEEP titration by transpulmonary pressure on respiratory mechanics in ARDS patients

目的明确跨肺压滴定PEEP是否较ARDSNET的PEEP-FiO2方法更有利于改善ARDS患者呼吸力学。方法对ARDS患者给予ARDSNET法或跨肺压法选择PEEP通气30min,记录呼吸力学、气体交换和血流动力学指标,对比两种方法对ARDS患者呼吸力学的影响。结果17例ARDS患者纳入研究,结果显示:⑴呼吸力学:跨肺压法选择的PEEP为(13.5±4.4)cmH2O,高于ARDSNET法的(7.4±2.5)cmH2O(P=0.000),并且跨肺压法在吸气末跨肺压、呼气末跨肺压、肺组织顺应性和呼吸系统顺应性等指标都高于ARDSNET法(P<0.05)。⑵气体交换:跨肺压法的氧合指数为(240±48)mmHg,高于ARDSNET法的(208±48)mmHg(P=0.002)。⑶血流动力学:跨肺压法的CVP为(12.4±4.4)mmHg高于ARDSNET的(10.9±4.3)mmHg(P=0.008)。结论根据跨肺压滴定PEEP较ARDSNET法更有利于改善ARDS患者的呼吸力学。

Objective To determine whether PEEP titration by transpulmonary pressure is better than ARDSNET PEEP-FiO2 method in improving respiratory mechanics in ARDS patients.Methods PEEP selected by ARDSNET or transpulmonary pressure in ARDS patients.The respiratory mechanics,gas exchange and hemodynamics were recorded after ventilation for 30 minutes,and the effects of two methods on respiratory mechanics of ARDS patients were compared.Results Seventeen ARDS patients were included in the study.The results showed:(1)Respiratory mechanics:The PEEP selected by transpulmonary pressure or ARDSNET were(13.5±4.4)cmH2O vs.(7.4±2.5)cmH2O(P=0.000).At the level of PEEP guided by transpulmonary pressure,end-inspiratory transpulmonary pressure,end-expiratory transpulmonary pressure,lung compliance and respiratory system compliance were significant different from the level of PEEP guided by ARDSNET(P<0.05).(2)Gas exchange:PaO2/FiO2 of PEEP titrated by transpulmonary pressure or ARDSNET were(240±48)mmHg vs.(208±48)mmHg(P=0.002).(3)Hemodynamics:The CVP of PEEP titrated by transpulmonary pressure or ARDSNET were(12.4±4.4)mmHg vs.(10.9±4.3)mmHg(P=0.008).Conclusion PEEP guided based on transpulmonary pressure is more beneficial than it of ARDSNET in improving the respiratory mechanics in ARDS patients.