允许性高碳酸血症治疗ARDS对肺力学的影响  

Therapeutic effects of permissive hypercapnia on pulmonary mechanics in patients with acute respiratory distress syndrome

作　　者：陈彦[1] 张劲松[1] 康健[1] 张芹[1] 陈旭锋[1] 

机构地区：[1]南京医科大学第一附属医院急诊科,江苏省南京市210029

出　　处：《实用老年医学》2006年第6期382-384,共3页Practical Geriatrics

摘　　要：目的 探讨允许性高碳酸血症（PHC）对重度急性呼吸窘迫综合征（ARDS）肺力学及血流动力学的影响。方法 观察不同潮气量（VT）时，30例重度ARDS患者肺气体交换、肺力学的改变。结果 当VT从15ml／kg降至6ml／kg时，病人均出现PHC，动脉血氧分压、氧饱和度和混合静脉血氧饱和度显著降低（P〈0．05）。PHC时，气道压力显著降低，气道阻力明显增高（P〈0．05）。静态肺压力-容积曲线高位转折点对应的压力为（22．2±1．9）cmH2O，容积为10ml／kg。结论 在实施PHC时，只有当气道平台压〈20-25cmH2O时才有可能避免肺泡过度膨胀，减少呼吸机相关性肺损伤。Objective To explore the therapeutic effects of permissive hypercapnia （PHC） on pulmonary mechanics and hemodynamics in patients with acute respiratory distress syndrome（ARDS）. Methods Thirty patients with ARDS were involved in the experiment. Gas exchanges and pulmonary mechanics were observed at different tide volume （ Vr）. Results When VT dropped from 15 ml/kg to 6ml/kg, PHC was induced. Arterial oxygen pressure, oxygen saturation and mixed venous oxygen saturation decreased markedly （ P 〈 0.05 ）. Pressure of airway decreased markedly, but resistance of airway increased （ P 〈 0. 05 ）. In static pressure-volume curve, the pressure of upper inflection point was 22. 2 ± 1.9cmH2O,and the volume was 10 ml/kg. Conclusions Alveolar overdistension may be prevented only when airway plateau pressure is less than 20 -25cmH2O in PHC.

关 键 词：呼吸窘迫综合征 成人 高碳酸血 肺换气 

分 类 号：R563.8[医药卫生—呼吸系统]