肺复张治疗肺外源性急性呼吸窘迫综合征的效果评价

目的 观察肺复张对肺外源性急性呼吸窘迫综合征(ARDS)患者氧合指数氧分压(PaO2)/吸入氧气浓度(FiO2)]、呼吸力学及血流动力学的影响.方法 14例肺外源性ARDS患者行保护性肺通气,稳定后开始肺复张治疗.实施控制性肺膨胀(SI)进行肺复张,每8小时进行1次,共3天,纪录每天第1次患者治疗前及治疗后1小时的血气指标、呼吸机参数及肺复张前后的血流动力学指标.结果 1、2、3天肺复张治疗后1小时患者PaO2/FiO2较治疗前均有上升,(162.6±19.80)mmHg vs(220.93±34.10)mmHg,(195.6±24.40) mmHg vs (243.3±34.60)mmHg,(222.57±27.40) mmHg vs(254.71±38.90)mmHg(P＜0.05或＜0.0l)；气道峰压PIP:(35.64±2.71)cmH2O vs(34.07±2.58)cmH2O,(32.86±3.30)cmH2O vs(30.93±3.15)cmH2O,(30.14±2.66)cmH2O vs (28.07±3.27)cmH2O,P＜0.01]、气道平台压Pplat:(31.29±2.49)cmH2O vs (28.93±2.63) cmH2O,(28.79±3.02) cmH2O vs(26.86±3.13)cmH2O,(25.71±2.09)cmH2O vs(23.57±2.34)cmH2O,P＜0.01]在肺复张治疗后均下降,呼吸系统静态顺应性(Cst)在肺复张治疗后改善,且整体呈升高趋势(26.21±3.26)ml/cmH2O vs (30.14±3.70) ml/cmH2O,(29.36±4.25) ml/cmH2O vs (33.64±5.30) ml/cmH2O,(32.14±5.05) ml/cmH2O vs (35.57±5.57)ml/cmH2O,P＜0.01)]；14例患者中有9例在肺复张过程中心率升高、血压下降,但均能于复张后3分钟恢复至复张前水平,余患者肺复张过程中心率、血压未见明显波动,14例患者均无心律失常发生.结论 对于肺外源性ARDS,肺复张可明显改善氧合,改善呼吸系统顺应性,对血流动力学影响轻徽.

Effects of recruitment maneuvers in extrapulmonary acute respiratory distress syndrome

Objective To observe the influence of the recruitment maneuvers （RM） on the oxygenation index （PaO2/FiO2）, respiratory mechanics, haemodynamics of the patients with extrapulmonary acute respiratory distress syndrome （ARDS）. Methods Lung protective ventilation was implemented in 14 patients with extrapulmonary ARDS until they were in a steady state. Then＇ the sustained inflation （SI） was applied once every 8 hours for 3 days. The blood gas indices and ventilator parameters before the first SI and one hour after SI and the haemodynamics indices before and after SI were recorded every day. Results The oxygenation index （PaO2/FiO2 ） of the patients 1 hour after RM during 3 days rose,（162.64± 19.80）mmHg vs （220.93± 34.10） mmHg,（195.64± 24.40） mmHg vs （243.29±34.60） mmHg, （222.57±27.40） mmHg vs （254.71±38.90） mmHg（ P （0.05）. Both the peak inspiratory pressure （PIP）,（35.64±2.71） cmH2O vs （34.07±2.58） cmH20,（32.86±3.30） cmH2O vs （30. 93±3.15） cmH2O,（30.14±2.66） cmH2O vs （28.07±3.27） cmH2O （ P 〈0.01） and the plateau pressure （Pplat）, （31.29±2.49） cmH2O vs （28.93±2.63） cmH2O,（28.79±3.02） cmH2O vs （26.86±3.13） cmH20,（25.71±2.09）cmH20 vs （23.57± 2.34） cmH2O （ P d0.01） fell after the RM while the static compliance （Cst） of the respiratory system was improved after the RM and rose on the whole, （26.21±3.26） ml/cmH2O vs （30.14±3.70） ml/cmH2O, （29.36±4.25） ml/ cmH2O vs （33.64!5.30） ml/cmH2O,（32.14±5.05） ml/emH20 vs （35.57±5.57） ml/cmH2O （ P 〈0.01）. 9 of the 14 patients had heart rate increase and blood pressure decrease in the course of the RM, but 3 minutes after the RM their heart rate and blood pressure returned to the level before RM. The rest patients had no obvious fluctuations in heart rate and blood pressure and all the 14 patients had no cardiac arrhythmia during RM. Conclusion In extrapulmonary ARDS, RM evidently improves the oxygenation and the static compliance （Cst） of the respiratory system and has slight influence on haemodynamics.