液体控制对心肺复苏患者肺损伤的影响

目的观察心肺复苏患者液体控制对肺损伤的影响。方法将心脏骤停患者分为严格控制液体组（A组n=26）和非严格控制液体组（B组n=20）,均按照2005年心肺复苏指南推荐的方法进行CPR。气管插管,呼吸机辅助呼吸,并采用肺保护通气策略（适当PEEP加小潮气量）,两组患者均严密监测心电、血压、经皮血氧饱和度和血气分析,动态观察胸部CT。结果复苏成功后B组患者动脉血氧分压明显低于A组（45.6±32.5VS56.8±29.8,P〈0.001）,以后随着呼吸末正压得应用,逐渐缓慢提高至正常。B组患者机械通气时间明显长于A组（86±16.5h VS 58±18.8h P〈0.001）。心肺复苏患者心脏按压时间越长,肺部CT表现为肺内肺挫伤、局部渗出性实变越严重。B组双侧胸腔积液的量明显多于A组。结论复苏时控制液体入量可以减少肺部渗出、减少胸腔积液的产生,缩短机械通气时间。

The primary clinical study of acute lung injury in patients with cardiac-pulmonary resuscitation

Objective Aim To observe the effect of limited liquid to lung injury in patients with cardiac-pulmonary resuscitation.Methods 24 patients with cardiac-pulmonary resuscitation were divided into two groups：limited liquid group（group A n=26）,no limited liquid group（group B n=20）.CPR was consistent with recommendation of the 2005 guidelines.All patients were putted intubation tube and mechanical ventilation with a protective-ventilation strategy.And then experimental indexes such as electrocardiogram,blood pressure,transcutaneous oxygen saturation,artery blood gas and a computer scan of thorax were observed.Results The pressure of oxygen in arterial blood were significantly lower in group B than that in group A（45.6±32.5 VS 56.8±29.8,P〈0.001）after restoration of spontaneous circulation（ROSC）.Then it was gradually increasing to the normal level after using positive end-expiratory pressure.The duration of ventilation were significantly longer in group B than that in group A（86±16.5 h VS 58±18.8 h P〈0.001）.The quantity of hydrops of both side thoracic cavity in group B were more than these in group A.Conclusion Limiting liquid can reduce the effusion of lung and the quantity of pleural effusion and shorten the duration of ventilation in patients with cardiac-pulmonary resuscitation.