三种肺复张方法治疗重度肺外源性急性呼吸窘迫综合征的效果比较  

Comparison of three lung recruitment maneuvers in the treatment of severe extra-pulmonary acute respiratory distress syndrome

作　　者：杜磊[1] 吴倩[1] 邓扬嘉[1] Du Lei;Wu Qian;Deng Yangjia(Department of Emergency and Intensive Care Unit (ICU ),Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400011,China)

机构地区：[1]重庆市中医院急诊ICU,400011

出　　处：《中国综合临床》2019年第1期32-36,共5页Clinical Medicine of China

基　　金：重庆市医学科研计划项目(2013-2-087).

摘　　要：目的研究3种肺复张方法治疗重度肺外源性急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的疗效和不良反应。方法选取重庆市中医院急诊ICU2013年1月至2016年12月收治的肺外源性重度ARDS患者63例,按照随机数字法将患者分为3组,分别应用控制性肺膨胀法(sustained inflation,SI)、呼气末正压递增法(increment peep,IP)、压力控制法(pressure control ventilation,PCV)3种方法进行肺复张。对完成肺复张的患者记录肺复张前后氧合指数(oxygenation index ,PaO2/FiO2 ),未完成患者记录肺复张中止原因。记录用后两种方法完成肺复张的患者达到最大肺复张程度时的呼气末正压(positive endexpratong pressure,PEEP),记录3组患者14 d病死率,比较各组复张前后的临床特征及预后的差异。结果以PaO2/FiO2为标准,3种肺复张方法均能使肺明显复张,SI法组复张前、复张后5 min、复张后1 h的PaO2/FiO2分别为(70.4±14.8)、(306.8±97.5)、(229.6±116.2) mmHg;IP法组分别为(74.9±13.6)、(328.0±95.5)、(252.8±111.0) mmHg;PCV法组分别为(67.8±14.9)、(304.2±82.2)、(223.7±83.6) mmHg。各组间的复张效果差异无统计学意义(P>0.05),达到最大复张程度时IP法组的PEEP较PCV法组高[(20.3±2.5) cmH2O与(18.5±1.8) cmH2O,P<0.05],操作中3种方法导致肺复张中止的不良反应发生率有显著性差异[SI法组54.5%(12/22),IP法组35.0%(7/20),PCV法组9.6% (2/21)。P<0.05],14 d病死率SI法组为63.6%(14/22)、IP法组为70.0%(14/20)、PCV法组为61.9%(13/21),差异无统计学意义(P>0.05)。结论3种肺复张方法对重度肺外源性ARDS患者的肺复张作用相似。SI法的不良反应导致肺复张中止的概率最大,PCV法最小,相同肺复张效果下IP法较PCV法需要更高的PEEP,实际操作中应优选PCV法。Objective To investigate the efficacy and side effects of three recruitment maneuvers (RM) for severe extra-pulmonary acute respiratory distress syndrome (ARDS).Methods A total of sixty-three extra-pulmonary ARDS patients were enrolled and randomly divided into three groups, which were treated with sustained inflation (SI), increment of positive end-expiratory pressure (IP) and pressure control ventilation (PCV) respectively.The oxygenation index (PaO2/FiO2) before and after lung recruitment was recorded in patients with complete lung recruitment, and the cause of discontinuation of lung recruitment was recorded in patients with incomplete lung recruitment.Positive end-expiratory pressure (PEEP) was recorded in patients who completed lung recruitment with the latter two methods when they reached the maximum degree of lung recruitment.The mortality rate of 14 d in 3 groups was recorded, and the clinical characteristics and prognosis differences were compared before and after each group.Results With PaO2/FiO2 as the standard, all the three methods of pulmonary reexpansion could make the lungs obviously reexpanse.The PaO2/FiO2 of each group before, 5 minutes after and 1 hour after reexpansion were respectively as below (SI group: 70.4±14.8 mmHg, 306.8±97.5 mmHg, 229.6±116.2 mmHg;IP group: 74.9±13.6 mmHg, 328.0±95.5 mmHg, 252.8±111.0 mmHg;PCV group: 67.8±14.9 mmHg, 304.2±82.2 mmHg, 223.7±83.6 mmHg.P<0.01). There were no significant differences among the three methods in the effect of RM (P>0.05). PEEP of IP group is higher than that of PCV group at the time of maximum RM (20.3±2.5 cmH2O vs.18.5±1.8 cmH2O, P<0.05). There were significant differences in the incidence of adverse reactions caused by the three methods (54.5% (12/22) in SI group, 35.0% (7/20) in IP group and 9.6% (2/21) in PCV group.The 14 d mortality of each group was 63.6% (14/22) in SI group, 70.0% (14/20) in IP group and 61.9% (13/21) in PCV group, with no significant difference (P>0.05).Conclusion The effects of three methods of lung recrui

关 键 词：急性呼吸窘迫综合征 肺复张 控制性肺膨胀法 呼气末正压递增法 压力控制法 

分 类 号：R563.8[医药卫生—呼吸系统]