肺复张术实施过程典型病例分析  

Analysis of Six Representative Episodes of Lung Recruitment Maneuver

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

机构地区：[1]同济大学附属上海市第十人是医院SICU,上海200072

出　　处：《麻醉与监护论坛》2007年第6期394-396,共3页Forum of Anesthesia and Monitoring

摘　　要：目的：总结6例典型肺复张术实施过程中的经验。 方法：对2005年7月-2007年10月期间实施的典型6例肺复张过程进行相对详细的介绍——基础疾病，肺复张方法、进程、效果等。肺复张采取固定驱动压，逐渐升高PEEP的方法。 结果：1例军团菌病患者在肺复张中发生纵隔气肿：1例肺炎，胸腔积液患者因存在房间隔缺损，导致复张无效；1例急性重症胰腺炎患者，有效PEEP最高达到30厘米水柱而对血流动力学无明显影响；1例脑出血,肺炎患者,初次肺复张无效,经纤维支气管镜从左右主支气管、多处段支气管开口处吸出大量黄脓痰,再次肺复张有效;1例膀胱癌术后并发肺部感染患者初次肺复张失败,经扩容治疗，第二次肺复张有效；1例脑出血并颅内高压患者应用6厘米水柱的PEEP,导致血压急剧，严重降低达15分钟以上。 结论：肺复张术中PEEP应用水平、效果、副反应受诸多因素的影响，肺复张术的实施必须遵循个体化的原则。Objective： To analyze 6 representative episodes of lung recruitment maneuver in patients with mechanical ventilation. Methods： To describe in relatively detail 6 representative episodes of lung recruitment maneuver（RM） in patients admitted to our department from July 2005 to October 2007 and to analyze the underlining disease, desired and undesired effects of lung recruitment maneuver, To elevate PEEP gradually and to keep the driving pressure at fixed level were the preferred methods to recruit the lung. Results： One patient with legionares＇disease developed pneumomediastinum. One patient with pneumonia and pieural effusion showed no effect due to an unrevealed patent foramen ovale. One patient with acute severe pancreatitis endured a maximal PEEP of 30 cmH20 without adverse effects on cardiovascular system, One patient with intracerebral hemorrhage and nosocomial pneumonia failed to respond to recruitment maneuver initially and showed desired effect after suction of large mount of secretion through bronchoscope. One patient with cystectomy responded unsatisfiedly at the first RM due to complicated hypotension and manifested desired effect after volume replacement therapy. One patient with intra-cerebral hemorrhage sustained sharp and severe blood drop lasting for 15 minutes while receiving aggressive support of vasoconstrictive agents and volume replacement. Conclusion： The desired and adverse effects of PEEP during lung recruitment maneuver are subject to a series of factors, so the principle of individuality must be followed in the clinical practice when performing recruitment maneuver.

关 键 词：PEEP 肺复张 低氧血症 机械通气 

分 类 号：R541.63[医药卫生—心血管疾病] R657.51[医药卫生—内科学]