吸痰联合肺复张后不同呼气末正压水平对急性呼吸窘迫综合征患者肺气体交换的影响  

Effect of different levels positive end - expiratory pressure after endotracheal suction combined with lung recruitment on gas exchange of the patients with acute respiratory distress syndrome

作　　者：李娜[1] 李军文[1] 吕欢[1] 马俊萍[1] 杨晓燕[1] 程青虹[1] 

机构地区：[1]石河子大学医学院第一附属医院重症医学科,新疆石河子832002

出　　处：《中国急救医学》2012年第5期398-401,共4页Chinese Journal of Critical Care Medicine

基　　金：石河子大学研究生创新基金项目（No.YJCX2010-Y08）

摘　　要：目的 探讨吸痰联合肺复张后不同的呼气末正压（PEEP）水平对急性呼吸窘迫综合征（ARDS）机械通气患者肺气体交换的影响.方法 以22例ARDS机械通气患者为研究对象,吸痰后给予肺复张,在原有PEEP水平（P0）基础上调整.于调整后10、30、60 min监测患者在各压力水平氧分压（PaO2）、二氧化碳分压（PaCO2）、静脉血氧饱和度（SpO2）、氧合指数（PaO2/FiO2）及肺泡-动脉血氧分压（PA-aO2）变化.结果 与基础水平比较,PaO2、SpO2及PaO2/FiO2在各PEEP水平均显著升高（P〈0.05）.随着应用PEEP水平的不断增加,PaO2、SpO2、PaO2/FiO2也随之升高,其中设置P0＋4 cm H2O和P0＋6 cm H2O的压力水平PaO2、SpO2、PaO2/FiO2显著高于其他水平（P〈0.05）.与其他四组比较,P0＋4 cm H2O和P0＋6 cm H2O在30～60 min监测时段PaO2、SpO2及PaO2/FiO2下降趋势较小（P〈0.05）.应用不同PEEP水平测得的PA-aO2不同,随PEEP水平增加逐渐下降.与其他水平比较,应用P0＋4 cm H2O和P0＋6 cm H2O时PA-aO2显著降低.不同PEEP水平PaCO2比较差异无统计学意义（P〉0.05）.结论 ARDS机械通气患者在吸痰联合肺复张后选择在原有PEEP水平（P0）上增加4～6 cm H2O时,有利于维持患者复张后肺气体交换功能.Objective To evaluate the effects of different levels positive end - expiratory pressure（PEEP） on air exchange in the patients with acute respiratory distress syndrome（ARDS） after endotracheal suction combined with lung recruitment . Methods 22 ARDS patients with mechanical ventilation accepted lung recruitment after endotraeheal suction, then PEEP was set for six levels （ P0 - 4 cm H2O, P0 -2 cm H2O, P0 ＋0 cm H2O, P0 ＋2 cm H2O, P0 ＋4 cm H2O, P0 ＋6 cm H2O depend on Po ： the basic value of PEEP） in each patients. Then we measured PaO2, PaCO2, SpO2, PaO2/FiO2 and PA - aO2 after the application of each PEEP strategy for 10, 30 and 60 min. Results Compared with baseline, the levels of PaO2 , SpO2 and PaO2/FiO2 in each PEEP level at three times all increased （P 〈0.05）. With the increased PEEP level, PaO2, SpO2 and PaO2/FiO2 all increased. In the P0 ＋ 4 cm H2O and P0 ＋ 6 cm H2O groups, PaO2, SpO2 and PaO2/FiO2 levels were significantly higher than in other levels（ P 〈 0.05）. In addition, there was no obvious trend towards the decrease between 30 min and 60 rain in monitoring index of PaO2, SpO2 and PaO2/FiO2 compared with other PEEP（ P 〈 0. 05 ）. With the increased of PEEP level, P（A-a）O2 decreased. In P0 ＋4 cm H2O and P0 ＋6 cm H2O levels, PA-aO2 was significantly lower than in any other levels （P 〈 0.05 ）. PaCO2 remained constant throughout the study. Conclusion Mechanically ventilated patients after ARDS are treated with endotracheal suction combined with lung recruitment, P0 ＋ 4 cm H2O and P0 ＋ 6 cm H2O will benefit gas exchange.

关 键 词：急性呼吸窘迫综合征(ARDS) 吸痰 肺复张 呼气末正压(PEEP) 

分 类 号：R563.8[医药卫生—呼吸系统]