外科重症加强治疗病房252例次机械通气患者肺复张术分析  

The analysis of 252 episodes of recruitment maneuver during mechanical ventilation in surgery intensive care unit

作　　者：杨自建[1] 张翔宇[1] 樊海蓉[1] 蒋欣[1] 王启星[1] 沈菊芳[1] 陈亮[1] 

机构地区：[1]同济大学附属上海市第十人民医院SICU,200072

出　　处：《中国危重病急救医学》2007年第9期539-541,共3页Chinese Critical Care Medicine

摘　　要：目的总结肺复张术对机械通气患者血压、血氧饱和度（SO2）的影响及其临床效果。方法选择2005年7月-2007年2月46例实施肺复张术患者的临床资料,分析其复张效果、肺复张术的不良反应等。肺复张采取固定驱动压、逐渐升高呼气末正压（PEEP）的方法,所有肺复张患者均进行有创动脉血压监测。结果46例患者进行了252次肺复张术,其中1例军团菌肺炎患者发生纵隔气肿;1例患者因存在卵圆孔未闭,复张无效;肺复张总有效率为91%。肺复张中有效PEEP变化较大,最低8cmH2O（1cmH2O=0.098kPa）,最高30cmH2O;SO2维持最短0.4h,最长368h,平均每例患者接受5.48次,其中有1例患者最多接受16次肺复张术。23例患者在肺复张中曾经发生过低氧血症（占50%）,252次肺复张术中发生101次低氧血症（占40%）;开始诱发低氧血症的最低PEEP为8cmH2O,最高为22cmH2O,平均12.7cmH2O。25例患者肺复张中曾发生过血压短暂降低（占54%）,252次肺复张中有93次血压短暂降低（占37%）;开始出现血压下降的最低PEEP为6cmH2O,最高为23cmH2O,平均13.9cmH2O。结论肺复张术可以有效改善SO2,PEEP的设定应遵循个体化的原则。Objective To analyze the clinical effects of recruitment maneuver and the impacts on blood pressure and oxygen saturation in patients with mechanical ventilation. Methods To analyze all related data from 252 episodes of recruitment maneuver of 46 patients admitted from July 2005 to February 2007. Recruitment maneuver method： the drive pressure constant was kept at 15 cm H2O （1 cm H2O=0. 098 kPa） and the positive end - expiratory pressure （PEEP） level was increased gradually. Results Of the 252 episodes of recruitment maneuver, this procedure was effective in 91% of the patients, with pneumotborax and pneumo- mediastinum occurred in a patient with legionnaire pneumonia, and no improvement of oxygen saturation in one patient with patent foramen ovale. The value of effective PEEP used ranged from a minimum of 8 cm H2O to a maximum of 30 cm H2O and the duration of satisfactory oxygen saturation ranged from a minimum of 0.4 hour to a maximum of 368 hours. Averagely, each patient received 5.48 episodes of recruitment maneuver with one of the patients received 16 episodes of recruitment maneuver. Twenty- three out of the 46 patients （50%） had experienced an episode of hypoxemia. One hundred and one episodes of bypoxemia occurred in 252 recruitment maneuver （40%） and the minimum PEEP inducing bypoxemia is 8 cm H2O, and the maximum PEEP was 22 cm H2O, with an average value of 12.7 cm H2O. Twenty -five of the 46 patients （54%） bad experienced transient bypotension with 93 episodes of bypoxemia in 252 episodes of recruitment maneuver （37%）, and the minimum PEEP inducing bypotension was 6 cm H2O and the maximum PEEP was 23 cm H2O, with an average value of 13.9 cm H2O. Conclusion Recruitment maneuver could effectively improve oxygenation while the value of PEEP used should be individualized according to clinical condition.

关 键 词：肺复张术 低氧血症 机械通气 呼气末正压 

分 类 号：R686[医药卫生—骨科学]