肺复张对急性呼吸窘迫综合征患者开放吸痰后氧合及血流动力学的影响

目的研究肺复张（LR）对急性呼吸窘迫综合征（ARDS）患者开放吸痰（ETS）后的治疗价值。方法选择20例需要机械通气的ARDS／急性肺损伤（ALI）患者，在标准通气稳定30min后按流程随机分组。ETs＋LR组在ETs后立即实施LR，60min后行第2次ETS，但不实施LR；ETS—LR组在ETS后不实施LR，60min后行第2次ETS，并立即实施LR。监测实验过程中各时间点的动脉血氧分压（PaO2）及血流动力学参数，如中心静脉压（CVP）、心率（HR）、平均动脉压（MAP）。结果所有患者血流动力学参数基本稳定，无心律失常发生。患者实施ETS后PaO2显著下降，ETS前后比较差异有显著性（P均〈0．05）；ETS后实施与不实施LR比较，在5和15min时PaO2差异有显著性（P均〈0．05）。结论ARDS／ALI患者在ETS后立即予以LR，患者可以耐受，其血流动力学未受到显著干扰，且可以迅速改善低氧血症。

Effects of lung recruitment maneuver on oxygenation and hemodynamics after open endotracheal suctioning in acute respiratory distress syndrome

Objective To evaluate the treatment value of lung recruitment (LR) maneuver on oxygenation and hemodynamics in acute respiratory distress syndrome (ARDS) patients after open endotracheal suctioning (ETS). Methods Twenty ARDS/acute lung injury (ALI) patients requiring mechanical ventilation support were randomized into two groups after stabilizing for 30 minutes. Group 1: LRs were performed immediately after ETS (ETS+LR), and then ETS was repeated after 60 minutes without LR. Group 2: the first ETS was performed without LR (ETS-LR), and the second ETS was combined with LR after 60 minutes. Partial pressure of oxygen in artery (PaO_2), central venous pressure (CVP), heart rate (HR) and mean arterial pressure (MAP) were serially measured during the procedure. Results The hemodynamic parameters were stable in all patients, and no arrhythmia occurred. PaO_2 decreased significantly after ETS, but recovered rapidly in 5 and 15 minutes after LR (both P<0.05). Conclusion LR is effective in rapidly counteracting the deterioration in PaO_2 caused by open ETS in ARDS/ALI patients without interfering the hemodynamics.