小潮气量结合肺复张术对食管癌开胸术后早期急性呼吸窘迫综合征患者的疗效  

Clinical effect of lower tidal volume combine with lung recruitment maneuver on ARDS for post operative esophageal carcinoma surgery patients

作　　者：杨全会[1] 刘大为[2] 王海军[1] 张昊[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所加强医疗科,100021 [2]中国医学科学院北京协和医学院北京协和医院加强医疗科

出　　处：《中华外科杂志》2010年第19期1484-1487,共4页Chinese Journal of Surgery

摘　　要：目的 观察小潮气量（VT）结合肺复张术对食管癌开胸术后早期急性呼吸窘迫综合征（ARDS）患者的疗效与可能出现的不良反应.方法 2007年1月1日至2009年9月30日收治食管癌开胸术后早期ARDS患者26例,男性20例,女性6例;年龄51～76岁,平均65.5岁.患者术后循环稳定,因ARDS而不能脱离机械通气.监测并持续记录无创血压、脉搏氧饱和度,实行小VT通气结合呼吸末正压（PEEP）递增法进行肺复张.记录肺复张前及两次肺复张后30 min的PEEP水平及吸入氧浓度（FiO2）;监测静态肺顺应性（CLS）及动脉血气分析.结果 26例患者共实施肺复张术52次,全部患者在肺复张术后,FiO2减低,CLS增加,动脉血气分析改善.所有病例均顺利出院,未发生气压伤或其他并发症.结论 小VT结合肺复张策略可以有效改善食管癌开胸术后早期ARDS患者的低氧血症.Objective To study clinical effectiveness and possible side effects of lower tidal volume combine with lung recruitment on acute respiratory distress syndrome （ARDS）for post operative esophageal carcinoma surgery patients. Methods Twenty six hypoxemie post operative esophageal carcinoma surgery patients from Cancer Hospital and Peking Union Medical College Hospital were included from 1st January 2007 to 30th September 2009. There were 20 male and 6 female with an average age of 65.5 years（51-76years）. Circulation was stable among them. They could not weaned from mechanical ventilation due to ARDS.Bedside monitoring included noninvasive continuous artery blood pressure （NBP）,pulse oximetric saturation （SPO2）. Patients were ventilated on volume control mode. Tidal volumes set to 6 ml/kg. Recruitment maneuvers were conducted by stepwise rising of positive end expiratory pressure （PEEP）level. PEEP,fraction of inspired oxygen（FiO2 ）, static compliance of lung（CLS）and arterial blood gas aralysis（ABG）before and at 30 min after each of twice applying recruitment maneuvers were measured. Results Fifty-two recruitments were completed on these 26 cases. PaO2/FiO2 improved significantly in 26 cases. The level of FiO2 were significantly lowered, CLS were increased significantly 30 min after each of twice applying recruitment maneuvers in all 26 cases. No complication was encountered. All patients were discharged successfully. Conclusion Hypoxemia of ARDS following esophageal carcinoma surgery can be improved by lower tidal volume combine with lung recruitment maneuver.

关 键 词：食管癌 手术后并发症 急性呼吸窘迫综合征 肺复张术 

分 类 号：R686[医药卫生—骨科学]