两种不同肺复张策略在急性呼吸窘迫综合征治疗中的应用效果比较  

Comparison of Two Different Lung Recruitment Maneuvers in the Treatment of Acute Respiratory Distress Syndrome

作　　者：陈敏[1] 金良凤[2] 

机构地区：[1]华中科技大学同济医学院附属梨园医院急诊科,湖北武汉430077 [2]华中科技大学同济医学院附属梨园医院儿科,湖北武汉430077

出　　处：《武汉大学学报（医学版）》2014年第6期903-906,共4页Medical Journal of Wuhan University

摘　　要：目的:研究两种不同肺复张策略在急性呼吸窘迫综合征治疗中的应用效果。方法:选择我院接诊的60例急性呼吸窘迫综合征的患者设计试验进行研究。按照随机数表法,将患者分为A、B两组。A组采用双水平正压通气+压力支持通气模式改良叹气法的肺复张策略对患者实施肺复张,B组采用压力控制法的肺复张策略对患者实施肺复张。分别检测记录两组患者肺复张(RM)前后的各项呼吸指标和血流动力学的变化情况,并记录患者的机械通气时间、ICU住院时间及术后并发症的发生情况。结果:RM前,两组患者的PaO2/FiO2及Cstat无显著性差异(P>0.05);RM 30,60min后,患者的PaO2/FiO2及Cstat均较RM前明显升高(P<0.05),但两组比较无显著性差异(P>0.05);RM 2h后,A组患者的PaO2/FiO2及Cstat的水平明显高于B组,两组比较有显著性差异(P<0.05)。RM前,两组患者的HR、MAP、CVP水平均无显著性差异(P>0.05);RM 5min后,两组患者的HR、MAP、CVP水平与RM前有显著性差异(P<0.05);RM 10min后,A组患者的HR、MAP、CVP水平均得到明显改善,与RM前无显著性差异,B组患者的HR、MAP、CVP水平仍与RM前有显著性差异;RM 20min后,两组患者的HR、MAP、CVP水平与RM前无显著性差异(P>0.05)。A组的机械通气时间和ICU住院时间均明显短于B组,两组比较有统计学意义(P<0.01)。所有患者在肺复张后,床边正位胸片显示均未发生气胸、纵隔气肿,但A组中合并多器官功能衰竭的患者有2例,B组中合并多器官功能衰竭的患者有3例,两组比较无显著性差异(P>0.05)。结论:双水平正压通气+压力支持通气模式改良叹气法对急性呼吸窘迫综合征患者实施肺复张,效果良好,安全性高,值得临床推广应用。Objective：To study the application effects of two different lung recruitment maneuvers（RM）in the acute respiratory distress syndrome.Methods：Sixty cases of acute respiratory distress syndrome were studied.According to a random number table method,the patients were divided into A and B groups.Group A were treated with BiPAP pressure support ventilation mode＋Improved sigh law lung recruitment strategies to recruit lungs;group B were treated with Pressure Control Act of lung recruitment strategies to recruit lungs.The breathing index and he-modynamics changes of the two groups were detected before and after lung recruitment（recruitment maneuvers）,and the occurrence of mechanical ventilation in patients,length of ICU stay and postoperative complications were recorded.Results：Before RM,there was no significant difference in Cstat and PaO2/FiO2（P〉0.05）.After RM 30 min and 60 min,Cstat and PaO2/FiO2 were significantly higher than before RM（P〈0.05）,but there was no significant difference between the two groups（P〉0.05）.After RM 2h,the level of PaO2/FiO2 and Cstat of group A was significantly higher than group B（P〈0.05）.Before RM,no difference were found in RM,HR,MAP,and CVP（P〉0.05）between the two groups.After RM 5min,there was significant changes in HR,MAP,and CVP（P〈0.05）;After RM 10 min,HR,MAP,and CVP in patients of group A significantly improved to the levels before RM,but levels of HR,MAP,CVP in group B were still different from that before RM;After RM 20 min,there was no significant difference in levels of HR,MAP and CVP from that before RM in both groups（P〉0.05）.Duration of mechanical ventilation and ICU stay in group A were significantly shorter than in group B（P〈0.01）.After lung recruitment,anteroposterior chest radiograph showed no pneumothorax and mediastinal emphysema in all patients,but there were two cases of multiple organ failure in group A and three cases in group B（P〉0.05）.Conclusion：BiPAP pressure support ventilation mode＋improved s

关 键 词：急性呼吸窘迫综合征 肺复张 双水平正压通气 压力控制法 

分 类 号：R563.4[医药卫生—呼吸系统]