肺复张策略治疗肺内/外源性急性呼吸窘迫综合征比较研究

目的 对比研究肺复张策略（RM）对肺内／外源性急性呼吸窘迫综合征（ARDSp／ARDSexp）的影响。方法 选择37例ARDS机械通气的患者，其中ARDSp16例，ARDSexp21例，在非肌肉松弛状态下，采用高水平持续气道正压通气（CPAP），CPAP压力升至30cmH2O（1cmH2O=0．098kPa），屏气时间维持30s，然后在5～10s内将CPAP水平下调至治疗前的呼吸支持条件。结果 肺复张后与复张前比较，两组心率变化在RM过程中差异无显著性，两组RM后2min平均动脉压均明显升高（P均〈0．05），两组中心静脉压仅在RM后30s明显增高（P均〈0．05），气道峰压、平台压、平均气道压在30s均明显增加（P均〈0．05）;两组动态肺顺应性RM后30s均明显下降（P均〈0．05），ARDSexp组RM后5、15和30min较复张前均明显增加（P均〈0．05）。ARDSp组RM后10、30min和1h氧合指数与治疗前比较差异均有显著性（P均〈0．05），ARDSexp组RM后10min、30min、1h、2h氧合指数与治疗前比较差异均有显著性（P均〈0．05）。结论 以肺间质水肿为主要改变的ARDSexp对RM的反应要比以肺实变为主要改变的ARDSp效果好。

Comparative study on recruitment maneuvers in acute respiratory distress syndrome with pulmonary and extrapulmonary origin

OBJECTIVE: To study the effects of lung recruitment maneuvers (RM) in acute respiratory distress syndrome (ARDS) with pulmonary and extrapulmonary origin (ARDSp/ARDSexp). METHODS: Thirty-seven ARDS patients with a forced expiratory volume were selected (16 with ARDSp, 21 with ARDSexp). Without using any sedative and neuromuscular blocking agents, with continuous positive airway pressure (CPAP) up to 30 cm H(2)O (1 cm H(2)O=0.098 kPa), the patients were asked to hold the breath for 30 seconds, and then CPAP was lowered to the level of that before the treatment within 5-10 seconds. RESULTS: Compared with the state before recruitment, changes in heart rate (HR) were not obvious in two groups during RM, mean arterial pressure was elevated evidently after 2 minutes in two groups (both P<0.05), and central venous pressure (CVP) rose after 30 seconds in two groups (both P<0.05). Peak inspiratory pressure, platform pressure and mean airway pressure increased clearly after 30 seconds (all P<0.05), and pulmonary compliance decreased obviously 30 seconds after re-inflation recruitment in two groups (both P<0.05), and increased obviously in ARDSexp group 5, 15, 30 minutes after recruitment (all P<0.05). In the group with ARDSp oxygenation index (OI) changed distinctly 10, 30 minutes and 1 hour after recruitment compared with the state before recruitment (all P<0.05). In patients with ARDSexp OI was significantly improved 10 minutes, 30 minutes, 1 hour, 2 hours after RM. CONCLUSION: In ARDSexp, with pulmonary interstitial edema as the main pathology, responded better to RM than ARDSp with pulmonary consolidation.