氮气洗入／洗出法测定急性肺损伤患者肺复张容积的研究  

The value of nitrogen washout/washin method in assessing alveolar recruitment volume in acute lung injury patients

作　　者：李洋[1] 汤睿[1] 黄英姿[1] 张运行[1] 毛自若[1] 潘纯[1] 刘松桥[1] 郭凤梅[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院重症医学科,南京210009

出　　处：《中华内科杂志》2013年第4期295-298,共4页Chinese Journal of Internal Medicine

基　　金：国家临床重点专科建设项目（2100299）;卫生公益性行业科研专项经费项目（201202011）;江苏省“科教兴卫工程”医学重点学科项目KJXW11（3）

摘　　要：目的探讨氮气洗人／洗出法测急性肺损伤（ALI）患者肺复张容积的准确性及可行性。方法将15例有创机械通气的ALI患者纳入本研究，根据ARDSnet法和跨肺压法滴定2种呼气末正压（PEEP）水平，分别通气30min，记录各PEEP水平下潮气量（Vt）、气道平台压等呼吸力学及血流动力学指标，并利用氮气洗人／洗出法测2种PEEP水平的呼气末肺容积（EELV），根据公式推算氮气洗／V洗出法测的肺复张容积，同时根据低流速压力-容积（P—V）曲线法获得肺复张容积，比较2种方法获得的肺复张容积的相关性及一致性。结果（1）ARDSnet法滴定的PEEP为（7±2）cmH：O（1cmH：0=0．098kPa），气道峰压为（23±5）cmH：0，气道平台压为（17±4）cmH：O；跨肺压法滴定的PEEP为（14±5）cmH：O，气道峰压为（28±6）cmH20，气道平台压为（22±6）cmH20，2种方法比较差异有统计学意义（P〈0．05）。（2）低流速P—V曲线法测的肺复张容积为100（一25～185）ml，氮气洗人／洗出法测的肺复张容积为180（一19—255）ml，两者具有较好的相关性，R。=0．755，P〈0．0001，且测量误差为46（8—80）ml。结论氮气洗人／洗出法可测定ALI患者的肺复张容积。Objective To evaluate the precision and feasibility of nitrogen washout/washin method in assessing lung recruitment of acute lung injury（ALI） patients. Methods Fifteen ALI patients underwent mechanical ventilation were involved. Two positive end-expiratory pressure （PEEP） levels （ high and low） were adjusted according to ARDSnet recommendations or measurement of transpulmonary pressure, eaeh for 30 minutes. Tidal volume （ Vt ）, plateau of airway pressure （ Pplat ）, other respiratory mechanics, gas- exchange and hemodynamies were measured. End expiration lung volume（EELV） was measured at different PEEP levels through nitrogen wasbout/washin method, and formula（ EELVhlshpEEp -EELVIowVEEe ） -Vt^owerEe/ （ PplahowPEEp -- PEEPIowPEEp ） x （ PEEPhigh - PEEPIow ） was used as recruitment （ Rec-N2 ）. Alveolar recruitment was measured using pressure-volume （P-V） curves （Rec-mes）. Correlation and consistency of Rec-N2 and Rec-mes were compared by correlation analysis and Bland-Altman technique. Results PEEP titrated by ARDSnet recommendations or transpulmonary pressure were （ 7 ~ 2 ） cm H20 （ 1 cm H20 - 0. 098 kPa） vs （14 ＋ 5） cm H20（P = 0. 008）; and there were significant differences in peak pressure （23 ＋5） cm H20 vs （28 ＋6） cm H20, plateau of airway pressure（17 ＋4）cm HzO vs （22 -＋6） cm H20, esophageal pressure, transpulmonary pressure and other respiratory mechanics between the two PEEP levels （ P 〈 0. 05 ）. The P-V curve technique gave Rec-mes a value of 100 （ - 25 ~ 185 ） ml. The nitrogen washout/ washin technique gave Rec-N2 a value of 180 （ - 19 ~ 255） ml, which showed a good correlation with a bias of 46 （ 8 - 80） ml （R2 = 0. 755, P 〈 0. 0001 ）. Conclusion Nitrogen washout/washin technique can be used to determine lung recruitment volume of ALI patients.

关 键 词：呼吸窘迫综合征 成人 肺复张容积 氮气洗入 洗出法 

分 类 号：R563.8[医药卫生—呼吸系统]