两种肺复张策略在急性呼吸窘迫综合征治疗中的应用比较  

Comparative study of two recruitment maneuvers in acute respiratory distress syndrome

作　　者：王存[1] 郭发良[1] 卜会驹[1] 黄辉[2] 莫伟胜[1] 杨秀洁[1] 林小茂[1] 

机构地区：[1]中山大学附属东华医院ICU,东莞523000 [2]中山大学孙逸仙纪念医院心内科

出　　处：《中国实用医刊》2013年第12期7-9,共3页Chinese Journal of Practical Medicine

基　　金：基金项目：东莞市科技计划医疗卫生类科研一般项目（201210515000388）

摘　　要：目的比较两种肺复张策略用于肺外源性急性呼吸窘迫综合征（ARDS）患者的效果及其对血流动力学的影响。方法肺外源性ARDS患者36例，按照交叉设计的方法在不同时段随机选用双水平正压通气＋压力支持通气（BILEVEL4-PSV）模式改良叹气法及压力控制法，记录肺复张前后患者氧合指数（PaO2／FiO2）、肺静态顺应性（Cstat）、心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）等指标的变化，并行统计学分析。结果两种肺复张方法患者PaO2／FiO2和Cstat在肺复张后比肺复张前均有改善，在肺复张后30、60min两种肺复张方法效果比较差异无统计学意义，而复张后120min BILEVEL＋PSV模式改良叹气法患者PaO2／FiO2[（210．2±29．7）mmHgvs（162．8±27．8）mmHg，1mmHg=0．133kPa]和Cstat[（43．3±12．0）vs（32．9±9．6）ml／cmH2O，1cmH2O：0．098kPa]均较压力控制法好，差异有统计学意义（P〈0．05）。两肺复张方法在复张后即刻对HR、MAP、CVP均有影响，而BILEVEL＋PSV模式改良叹气法在肺复张后10min患者HR、MAP、CVP已基本恢复到复张前水平，压力控制法肺复张后10min患者HR、CVP仍有升高，MAP仍较低，复张后20min才恢复到复张前水平。结论在肺外源性ARDS患者应用PB-840呼吸机实施BILEVEL＋PSV模式改良叹气法肺复张效果显著，改善氧合及肺顺应性较压力控制法维持时间长，并且患者耐受性好，对血流动力学影响小。Objective To compare the effect of two recruitment maneuvers（RM） in acute respiratory distress syndrome caused by extrapulmonary disease. Methods A total of 36 acute respiratory distress syndrome patients caused by extrapulmonary disease were enrolled. According to crossover design methods, they were undergone two RM in different periods, including Bi-level positive airway ＋ pressure support ventilation （ BILEVEL ＋ PSV） modified sigh and pressure control ventilation （PCV）. Oxygenation index（ PaO2/FiO2 ）, lung static compliance （Cstat）, and heart rate（HR）, mean arterial blood pressure（ MAP）, central venous pressure（ CVP）, were recorded before and after RM, and were analyzed for statistical analysis. Results PaO2/FiO2, Cstat were increased significantly after two RMs than before. There was no significantly different between the two methods in period of 30 min and 60 min after RM. PaO2/FiO2 and Cstat in period of 120 min after BILEVEL ＋ PSV modified sigh were significantly higher than that of PCV [ PaO2/FiO2 ： （210. 2 ± 29. 7） mm Hg vs （ 162. 8 ±27.8） mm Hg, Cstat： （43.3 ±12. 0）ml/cm H2O vs （32.9 ±9.6）ml/cm H2O, P 〈 0.05]. After RM, HR and CVP were increased, MAP was decreased at once, and there was no difference in two methods. HR, MAP and CVP restored to the previous levels in period of 10 min after BILEVEL ＋ PSV modified sigh, but in period of 20 min after PCV. Conclusions BILEVEL ＋ PSV modified sigh using PB-840 ventilator can be applied to the patients suffering from extrapulmonary acute respiratory distress syndrome, and can improve oxygenation index, lung static compliance significantly. It can maintain a longer time and better tolerance and lighter interference to hemodynamic than PCV.

关 键 词：急性呼吸窘迫综合征 肺复张 双水平正压通气 改良叹气法 压力控制法 

分 类 号：R563.8[医药卫生—呼吸系统]