纤支镜支气管镜肺泡灌洗吸痰对重症患者呼吸力学及血液动力学的影响及相应对策的研究

Effects of Bronchoscopic Lavage with Alveolar Lavage on Respiratory Mechanics and Hemodynamics in Patients with Severe Disease and Corresponding Countermeasures

目的研究机械通气重症患者行肺泡灌洗前后呼吸力学及血液动力学的变化,探寻机械通气重症患者行肺泡灌洗后复张所需的理想PEEP,达到治疗效果与操作风险的最佳结合点。方法方便选取该院于2016年1月—2018年1月收治的60例行有创机械通气的重症患者作为研究对象,随机分为对照组(PPEP5组)和观察组(PEEP10组),每组30例,观察比较两组患者灌洗前后的动脉血气和氧代谢情况、呼吸力学参数指标对比情况、血流动力学参数指标对比情况。结果 1两组患者与肺泡灌洗前对比,在肺泡灌洗后PaO2出现明显下降,心率及中心静脉压较肺泡灌洗前增快(P<0.05)。2PEEP10组患者恢复到纤维支气管镜检查前水平所需时间为(10.3±2.3)min,较PEEP5组(15.7±3.7)min明显缩短,差异有统计学意义(t=6.312,P<0.05)。结论采用肺泡灌洗后加用适当的PEEP能复张塌陷的肺泡,改善肺顺应性,减少低氧血症对机体的危害,并对血流动力学影响较小,是安全有效的方法。

Objective To study the changes of respiratory mechanics and hemodynamics in patients with severe mechanical ventilation before and after alveolar lavage,and to explore the ideal PEEP for patients with severe mechanical ventilation after re-expansion of alveolar lavage,to achieve the best therapeutic binding point effect and operational risk.Methods 60 patients with invasive mechanical ventilation who were admitted to the hospital from January 2016 to January 2018 were convenient randomly divided into the control group(PPEP5 group)and the observation group(PEEP10 group).For example,the arterial blood gas and oxygen metabolism,the comparison of respiratory mechanics parameters and the comparison of hemodynamic parameters were compared between the two groups.Results 1.Compared with before alveolar lavage,PaO2 decreased significantly after alveolar lavage,and heart rate and central venous pressure increased faster than before alveolar lavage(P<0.05).2.The time required for the PEEP10 group to return to the level before the fiberoptic bronchoscopy was(10.3±2.3)min,which was significantly shorter than that of the PEEP5 group(15.7±3.7)min.The difference was statistically significant(t=6.312,P<0.05).Conclusion The use of appropriate PEEP after alveolar lavage can recapture the collapsed alveoli,improve lung compliance,reduce the harm of hypoxemia to the body,and have less impact on hemodynamics.It is a safe and effective method.