吸痰后不同呼气末正压水平的肺复张对急性呼吸窘迫综合征患者血流动力学的影响

目的：探讨吸痰联合肺复张后调整不同的呼气束正压（PEEP）水平对急性呼吸窘迫综合症（ARDS）机械通气患者血流动力学的影响0方法：采取自身对照研究方法，30例ARDS机械通气患者，吸痰后给予肺复张，在原有PEEP水平（P0）基础上调整0所有患者在调整PEEP后10min、15min和30min通过心电监护仪记录心率（HR）、中心静脉压（CVP）、心输出量（CO）及肺动脉楔压（PAWP），同时记录患者性别、年龄、治疗前APACHE-Ⅱ结果：吸痰后给予不同PEEP水平的肺复张干预，ARDS患者HR、CVP、CO及PAWP在不同时间点的差异有统计学意义（P均〈0．05）；吸痰后15min时，P0＋0与P0＋4、P0＋0与P0＋6之间的CVP、CO及PAWP有统计学差异（P均〈0．05），吸痰后30min时，P04-0与P0＋4、P0＋0与P0＋6之间的CVP、CO及PAWP恢复至吸痰前水平，无明显统计学意义0结论：吸痰后联合较高PEEP水平的肺复张对ARDS患者血流动力学的影响轻微，持续时间短，是一种安全的护理措施0

Lung Recruitment Used by Different Levels Positive End-expiratory Pressure after Endotracheal Suction in Patients with the Acute Respiratory Distress Syndrome：Effects on Transient Hemodynamic

Objective： To explore transient hemodynamic effects of Lung Recruitment Used by Different Levels Posi- tive End-expiratory Pressure （peep） after Endotracheal Suction in patients with the acute respiratory distress syndrome （ARDS）. Methods： Study with 30 mechanical ventilated patients with ARDS. we conducted a recruitment maneuver after endotracheal suction,then set PEEP for four levels （Po ＋0cm H20,Po ＋2cm H20,P0 ＋4cm H20,Po ＋6cm H20） dependon P0 ：the basic Value of PEEP in each patients. Hear rate （HR） ,central venous pressure （CVP） ,cardiac output （CO） and painaiy arery wedge pressure（PAWP） changes were observed in time point before suctioning, 10,15,30 minutes af- ter suctioning,respectively. Results：Hemedynamic indexes changed over time from time point before suctioning to 30 mi- nutes after suctioning. The differences were statistically significant （ P 〈 0.05 ） ; and except for the CVP, CO, PAWP at 15 minutes after suctioning, comparison in other hemodynamic indexes in different certain time points among different recruit- ment maneuvers revealed on statistically significant result, the CVP, CO, PAWP at 30 minutes after suctioning, comparison in other hemodynamic indexes in different certain time points among different recruitment maneuvers revealed Non-statistical meaning. Conclusion： Recruitment maneuvers exerted little impacts on hemedynamic change in canine model of ARDS after endotracheal suction, suggesting that it is a relatively safe nursing intervention.