应用肺复张法治疗肺内源性和肺外源性急性呼吸窘迫综合征的比较  

Comparison of Effects of Recruitment Maneuver on Acute Respiratory Distress Syndromes of Intra-and Extra-pulmonary Origins

作　　者：姜利[1] 席修明[1] 朱波[1] 

机构地区：[1]首都医科大学附属复兴医院ICU

出　　处：《首都医科大学学报》2007年第5期558-561,共4页Journal of Capital Medical University

基　　金：北京市科技计划重大项目(H020920050230)资助~~

摘　　要：目的探讨应用肺复张法(RM)治疗肺内源性和肺外源性急性呼吸窘迫综合征(ARDS)对氧合、呼吸力学参数及预后影响的差异。方法53例ARDS患者,依其病因分为肺内源性ARDS组(n=25)和肺外源性ARDS组(n=28)。采用持续气道正压(CPAP)40cmH2O,40s完成肺复张法。分别观察2组患者动脉血气分析、呼吸力学参数和预后指标,比较2组上述参数的差异。结果RM第1,2天后2h的氧合指数显著高于RM前,但2组间氧合差异无统计学意义。2组呼吸力学改变及预后指标差异均未见统计学意义。结论RM可以显著改善ARDS患者的氧合。RM对肺内源性ARDS和肺外源性ARDS患者氧合、呼吸力学参数变化和预后影响的差异无统计学意义。Objective To compare the effects of recruitment maneuver in intra-and extra-pulmonary acute respiratory distress syndromes. Methods Fifty-three patients with ARDS who received recruitment maneuver（RM） were assigned into group ADRSp （n = 25 ） and group ARDSexp（ n = 28 ） according to the causes.of lung injury. All the patients were ventilated with tidal volume of 6 mL/kg of predicted body weight and limited plateau pressure less than 30 cmH20. RMs were conducted by applying CPAP of 40 cmH20 for 40 s, repeated every 8 hours during the first 5 days. If the patient began weaning within the first 5 days, RMs were stopped. Both physiologic data and outcome measurements, including arterial blood gas （PaO2, PaCO2 ）, airway pressure （peak pressure, plateau pressure）, ventilator settings（ tidal volume, PEEP, FiO2 ） , hemodynamic parameters, ICU-free days by day 28, ventilator-free days by day 28 and rate of survival with unassisted breathing by day 28, ICU and 28-day mortality, were compared between 2 groups. Results The PaO2/ FiO2 increased after RM on day 1 and day 2（ 144.9 mmHg vs 128.0 mmHg, P =0. 007, 205.0 mmHg vs 175.0 mmHg, P =0. 001, respectively）, accomparied by significant decrease in FiO2 （0.58± 0.16 vs 0.68 ± 0.22, P = 0.001 ;0.53 ± 0.15 vs 0. 54 ± 0.15, P = 0. 017 ; respectively）. But there was no significant difference in changes of PaO2/FiO2 and FiO2 between two groups, so was also PaCO2. During the first 5 days, no differences in peak pressure and plateau pressure between 2 groups were found. Each time when RM was conducted, no difference in heart rate and mean blood pressure before RM and 0.5, 1, 2, 4, 6-hours after RM were found. There were also no differences in ICU-free days, ventilator-free days, rate of survival with unassisted breathing, ICU and 28-day mortality between 2 groups. Only one patient was reported to suffer from low blood pressure when RM was performed. There were no incidence of barotraumas and other adverse effects. Conclusion RM is safe and effective

关 键 词：急性肺损伤 急性呼吸窘迫综合征 肺复张法 预后 

分 类 号：R563.8[医药卫生—呼吸系统]