肺泡灌洗对肺源性急性呼吸窘迫综合征肺复张容积和肺力学的影响  

Effects of bronchoalvelolar lavage on lung recruited volume and pulmonary mechanic in patients with pulmonary acute respiratory distress syndrome

作　　者：张庚[1] 徐再春[1] 胡马洪[1] 

机构地区：[1]浙江省立同德医院ICU,浙江杭州310012

出　　处：《中国内镜杂志》2005年第9期913-916,共4页China Journal of Endoscopy

摘　　要：目的评价肺泡灌洗(BAL)对肺原性急性呼吸窘迫综合征(ARDSp)肺复张和肺力学的影响,以探讨BAL对ARDSp的治疗作用。方法以9例血液动力学稳定、接受机械通气的ARDSp患者为研究对象,采用压力-容积曲线法分别测定BAL前与后呼气末正压(PEEP)为5、10和15cmH2O(1cmH2O=0.098mmHg)时的肺复张容积,并对BAL前后气道峰压(PIP)、气道平台压(Pplat)、平均气道压(Pm)和静态顺应性(Cst)在不同PEEP下的趋势变化进行比较。结果BAL前PEEP至5、10和15cmH2O时肺复张容积分别为([35.89±3.93)mL(、124.56±9.68)mL和(161.70±8.50)mL,P<0.01],BAL后分别为[(42.27±4.27)mL、(139.70±17.59)mL和(160.16±9.43)mL,P<0.01]。但BAL前后组间趋势变化差异无显著性(F=2.749,P=0.079)。不同PEEP条件下BAL后PIP、Ppla和Pm较BAL前趋势有显著下降(P<0.05),Cst在BAL前后比较差异无显著性(P>0.05)。结论BAL对肺复张容积无显著影响,但显著降低ARDSp的气道压力,改善通气功能。[Objective ] To access alveolar recruitment and pulmonary mechanic with Bronchoalveolar lavage （BAL） in different positive end-expiratory pressure （PEEP） levels in patients with pulmonary acute respiratory distress syndrome （ARDSp）. [Methods] Nine ventilated patients satisfying criterial of ARDRp were included in the study group. Recruited volume of three different PEEP levels [5 cmH2O （1 cmH2O=0.098 Kpa）, 10 cmH2O, 15 cmH2O] were measured by pressure-volume cure method before and after BAL and compared . Trending change of different PEEP levels on lung mechanics[peak airway pressure（PIP）, Plateau pressure （Pplat）, mean airway pressure （Pro） and static compliance（Cst） were compared. [Results] Lung recruited volume elevated when PEEP increased from 5 cmH2O to 15 cmH2O [（35.89±3.93） mL vs.（124.56±9.68）ml vs.（161.70±8.50） mL, P 〈0.01] before BAL and [（42.27±4.27） mL vs. （139.70±17.59） mL vs. （160.16±9.43） mL, P〈0.01] after BAL, but there was no significant difference in trending change between them （F=2.749, P=0.079）. There was significant difference of trending change during PIP, Pplat and Pm at different PEEP levels before and after BAL （P 〈0.05）. There was no significant difference in it during Cst （P 〉0.05）. [Conclusions] BAL was not effective to recruited volume with ARDSp, but it reduced significantly lung airway pressure and improved ventilation.

关 键 词：肺原性呼吸窘迫综合征 支气管-肺泡灌洗 肺复张容积 呼气末正压 

分 类 号：R563[医药卫生—呼吸系统]