利用压力-容积曲线呼气支最大曲率拐点选择PEEP对ARDS患者氧合及血流动力学的影响  

Effects of PEEP by using the inflection point of maximum curvature of the pressure - volume curves deflation limb on oxygenation and hemodynamics in ARDS patients

作　　者：李晓峰[1] 尤伟艳[1] 朱桂云[1] 曾建琼[1] 

机构地区：[1]新疆石河子大学医学院第一附属医院重症医学科,新疆石河子832008

出　　处：《中国急救医学》2012年第7期586-588,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨利用压力一容积（P—V）曲线呼气支最大曲率拐点选择呼气末正压（PEEP）对急性呼吸窘迫综合征（ARDS）患者氧合及血流动力学影响。方法选取25例ARDS患者，采用肺保护性通气，肺复张（RM）后随机分为两组：利用P—V曲线呼气支最大曲率拐点设置PEEP组（PPMc）和以P—V曲线低位拐点设置PEEP组（PLIP），观察并比较RM前后两组患者PaO2／FiO2、呼吸系统动态顺应性（Cdyn）、心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）等指标的变化。结果RM后两组患者短时间内PaO：／FiO：和Cdyn均明显增加，PPMc组PaO2／FiO2在RM后1、2、4h较Pup组升高（P〈0．05）。PLIP组Cdyn在RM后很快降至RM前水平，PPMC组Cdyn在RM后1、2h高于PLIP组（P〈0．05）。两组RM时均有MAP、CVP下降，HR升高（P〈0．01）；HR、MAP在RM后很快恢复，PPMC组CVP持续升高至RM后2h（P〈0．05）。结论RM后利用P—V曲线呼气支最大曲率拐点选择PEEP可以使氧合及呼吸系统顺应性改善更为明显，对血流动力学无严重的不良影响。Objective To investigate the effects of positive end - expiratory pressure （PEEP） by using the point of maximum curvature （PMC） of the pressure- volume（ P- V） curves deflation limb on oxygenation and hemodynamics in patients with acute respiratory distress syndrome （ARDS）. Methods Static lung P - V curves were analyzed and the lower inflection point （LIP） and PMC from static P - V curves were determined in 25 patients with ARDS. To set ventilative PEEP by using PMC and LIP of P - V curves, 25 patients were randomized in two groups ： PPMC group and PuP group after recruitment maneuver （RM）. The effects of PEEP on gas exchange, homodynamic and airway pressure were observed in the two groups. Results PaO2/FiO2 and Cdyn in the two groups of patients were significantly increased shortly after RM, PaO2/FiO2 were higher in PPMC group at 1, 2, 4 h after RM than in PuP group（ P 〈 0. 05 ）. The Cdyn in PLIP group dropped very quickly, while the Cdyn were higher in PPMC group at 1,2 h after RM than in PLIP group （P 〈 0.05 ）. In both two groups, MAP and CVP decreased, and HR increased during RM（P 〈0.01 ）, HR, MAP recovered soon after RM. CVP in PPMC group increased till 2 h after RM （P 〈 0.05 ）. Conclusion The PEEP by using the point of maximum curvature of the pressure - volume curves deflation limb improves oxygenation and compliance of the respiratory system and has no obvious adverse effect on hemodynamics.

关 键 词：急性呼吸窘迫综合征(ARDS) 呼气末正压(PEEP) 压力-容积曲线 

分 类 号：R563.8[医药卫生—呼吸系统]