氧合导向肺外源性急性呼吸窘迫综合征最佳呼气末正压选择与最大肺静态顺应性相关性研究  

Correlation between oxygenation-guided selection of optimal positive end expiratory pressure and maximum static compliance in extrapulmonary acute respiratory distress syndrome

作　　者：韩玉[1] 代庆春[1] 沈洪丽[1] 苗晓云[1] 回志[1] 张晓卫[1] 

机构地区：[1]沧州市中心医院重症医学科,河北沧州061001

出　　处：《临床荟萃》2012年第22期1943-1945,共3页Clinical Focus

摘　　要：目的研究氧合导向肺外源性急性呼吸窘迫综合征(ARDS)最佳呼气末正压(PEEP)选择与最大肺静态顺应性(Cst)的相关性。方法 14例肺外源性ARDS患者充分肺复张后,采用最佳氧合法指导患者PEEP选择,每日进行1次,共3天,观察患者呼吸力学、血流动力学、肺气体交换指标的变化。结果最佳氧合法选择的PEEP计算出的Cst低于最大Cst,差异有统计学意义,第1天对比:(30.14±3.70)ml/cmH2O vs(33.57±4.43)ml/cmH2O(P<0.05);第2天对比:(32.93±5.05)ml/cmH2O vs(37.71±6.13)ml/cmH2O(P<0.05);第3天对比:(34.50±4.55)ml/cmH2O vs(39.07±6.44)ml/cmH2O(P<0.05)。最大Cst对应的PEEP低于最佳氧合法选择的PEEP,差异有统计学意义,第1天对比:(11.71±2.33)cmH2O vs(14.85±2.45)cmH2O(均P<0.01);第2天对比:(11.57±3.06)cmH2O vs(14.14±2.88)cmH2O(P<0.05);第3天对比:(10.86±2.45)cmH2O vs(13.29±2.43)cmH2O(P<0.05)。结论最佳氧合法选择的PEEP未使Cst最大化,可能与造成部分肺泡过度膨胀有关,虽然能明显改善氧合,但也可能加重局部肺损伤。Objective To discuss the correlation between the oxygenation-guided selection of the optimal positive end expiratory pressure（PEEP） and the maximum static compliance（Cst） in extrapulmonary acute respiratory distress syndrome（ARDS）.Methods After full recruitment maneuvers,the oxygenation-guided selection of the PEEPs of 14 patients with extrapulmonary ARDS were made once a day for three days,during which changes in indices of respiratory mechanics,haemodynamics and pulmonary gas exchange were observed.Results The Cst calculated according to the PEEP selected by way of the best oxygenation was lower than the maximum Cst,there was significant difference.Comparison on the first day：（30.14±3.70） ml/cmH2O vs（33.57±4.43） ml/cmH2O（P〈0.05）;Comparison on the second day：（32.93±5.05） ml/cmH2O vs（37.71±6.13） ml/cmH2O（P〈0.05）;Comparison on the third day：（34.50±4.55） ml/cmH2O vs（39.07±6.44） ml/cmH2O（P〈0.05）.The corresponding PEEP of the maximum Cst was lower than the PEEP selected by means of the best oxygenation.There was significant difference.Comparison on the first day：（11.71±2.33） cmH2O vs（14.85±2.45） cmH2O（P0.01）;Comparison on the second day：（11.57±3.06） cmH2O vs（14.14±2.88） cmH2O（P〈0.05）;Comparison on the third day：（10.86±2.45） cmH2O vs（13.29±2.43） cmH2O（P〈0.05）.Conclusion The PEEP selected by the best oxygenation does not maximize the Cst,probably because causing overexpansion of some pulmonary alveoli and it is likely to worsen partial lung injury,although it improves the oxygenation obviously.

关 键 词：呼吸窘迫综合征 成人 呼吸 人工 正压呼吸 肺顺应性 

分 类 号：R563.8[医药卫生—呼吸系统]