不同肺复张模式对ARDS患者呼吸力学及呼出气冷凝液炎症因子的影响

目的：比较控制性肺膨胀（SI）和压力控制（PCV）两种肺复张模式对急性呼吸窘迫综合征（ARDS）患者肺氧合功能、呼吸力学、呼出气冷凝液炎症因子及血流动力学的影响。方法45例ARDS患者随机分为对照组、SI组和PCV组。对照组使用保护性肺通气治疗；S I组在保护性肺通气基础上使用控制性肺膨胀治疗；PC V组联合压控法肺复张治疗。每12 h重复1次RM ，连续3 d。观察各组患者治疗前、治疗12、24、48、72 h各时间点氧合指数（PaO2／FiO2）、气道峰压（PIP ）、气道平台压（Pplat）、静态肺顺应性（Cst）。检测治疗前、治疗24、72 h呼出气冷凝液（EBC）中 TNF‐α、IL‐6、IL‐10水平，监测SI组与PCV组RM前后血流动力学变化。结果①三组患者治疗12、24、48、72 h各时间点PaO2／FiO2、Cst均呈上升趋势，PIP、Pplat呈下降趋势，与治疗前比较均有统计学意义；同时间点RM组（SI组和PCV组）PaO2／FiO2、Cst高于对照组，PIP、Pplat低于对照组，比较有统计学意义，但上述指标SI组与PCV组比较无统计学意义。②SI组与PCV组患者治疗后呼出气冷凝液（EBC ）中TNF‐α、IL‐6、IL‐10水平均呈下降趋势，在治疗后24、72 h与治疗前比较均有统计学意义，但SI组与PCV组比较差异无统计学意义。③SI组与PCV组在肺复张时MAP下降，HR、CVP升高，与复张前比较差异显著，PCV组上述指标波动幅度及持续时间均低于SI组，在肺复张时、复张后60、120、300 s两组上述指标比较差异有统计学意义。结论 SI与 PCV两种肺复张均能改善ARDS患者肺氧合功能、增加肺顺应性，降低平台压，减轻肺部炎症反应；PCV肺复张对血流动力学影响低于SI。

Effects of various lung recruitment maneuvers on respiratory mechanics and inflammatory cytokines in exhaled breath condensate of patients with ARDS

Objective To investigate the effects of recruitment maneuvers (RM ) with substained inflation (SI) and pressure control ventilation (PCV) on oxygenation ,respiratory mechanics ,concentration of inflammatory cytokine in exhaled breath con‐densate (EBC) and hemodynamics in patients with acute respiratory distress syndrome (ARDS) .Methods Forty‐five patients with ARDS were randomized into control group ,SI group and PCV group .The patients of SI group received RM with continu‐ous positive airway pressure ,the PCV group patients received pressure control ventilation and the control group patients re‐ceived lung protective strategy without RM .The RMs were performed and repeated once every 12 hours ,lasting 3 days .Pa‐rameters of Oxygenation index (PaO2/FiO2 ) ,Peak inspiratory pressure (PIP) ,Plateau pressure (Pplat) and Static pulmonary compliance (Cst) of patients before the trial and at 12 ,24 ,48 ,72 h of the test were measured and compared between groups . The TNF‐α,IL‐6 and IL‐10 level in exhaled breath condensate collected before the trial and at 24 and 72 h was analyzed by ELISA .Hemodynamics changes before and after every RM were monitored .Results ①The PaO2/FiO2 and Cst of three groups showed upward trend after treatment and the PIP and Pplat showed downward trend after treatment .The changes were signifi‐cantly different among the control group and the two recruitment groups ,but not significantly different between recruitment groups .②The TNF‐α,IL‐6 and IL‐10 level in exhaled breath condensate of SI group and PCV group showed downward trend after treatment ,but there were not significantly different between the two groups .③ The MAP and CI of two recruitment groups both showed downward trend and the HR and CVP showed upward trend during and after RM .The wave amplitude and duration of the Parameters of PCV group were lower than that of SI group ,and the change was significantly different at the point of RM and 60 ,120 ,300 s after RM .Conclusion RMs with PCV and SI could reduce inflammatory reaction in the lung tis‐sue ,increasing oxygenation and lung compliance .The effect of PCV on hemodynamic was lower than SI .