低容量负荷对创伤后ARDS肺功能的保护作用研究  

Protective Effect of Low Volume Load on Lung Dysfunction of Patients with Acute Respiratory Distress Syndrome after Injury

作　　者：王晓峰[1] 郭海华[2] 郝智泉[1] 李小飞[2] 高坤祥[2] 

机构地区：[1]韩城矿务局总医院,陕西韩城715400 [2]第四军医大学唐都医院胸腔外科,陕西西安710038

出　　处：《现代生物医学进展》2015年第8期1518-1521,共4页Progress in Modern Biomedicine

基　　金：全军医药卫生科研基金项目(06M264);陕西省科技攻关项目(2009K18-02-6)

摘　　要：目的:观察低容量负荷对创伤后急性呼吸窘迫综合征(ARDS)肺功能的保护作用。方法:165例创伤后ARDS患者随机分为液体控制组和对照组,用脉搏指示连续心输出量监测(Pi CCO)指导液体控制,观察中心静脉压(CVP)、肺动脉楔压(PAWP)、氧合指数(Pa O2/Fi O2)、肺泡-肺动脉氧分压差,测定肺泡灌洗液中白细胞介素6(IL-6)水平、血清的肺泡表面活性蛋白D(SP-D)水平的变化,检测呼吸机脱机时间,评估两组患者肺功能的恢复情况。结果:液体控制组血管外肺水肿指数(EVLWI)、CVP、PWAP、IL-6、SP-D以及肺泡-动脉氧分压差均较对照组明显下降(P<0.05),动脉血气氧分压、氧合指数较均对照组明显升高(P<0.05),机械通气支持时间较对照组明显缩短(P<0.05)。结论:严格的液体控制可有效降低人体的容量负荷,有效促进创伤后ARDS肺损伤和肺功能的恢复,这可能与低容量负荷能够降低炎症反应、促进肺泡复张和改善氧合效率有关。Objective： To observe the protective effectof low volume load on the lung dysfunction of patients with acute respiratory distress syndrome after injury. Methods： 165 ARDS patients with trauma were randomly divided into the liquid management group and control group. Pi CCO was used to monitor the liquid management, which consisted of CVP, PAWP, Pa O2/Fi O2. The concentration of IL-6 in lung lavage fluid and the concentration of SP-D in plasma were detected before and after curing. Besides, the arterial blood gas analysis and the weanning time of respirator were recorded. Results： The CVP, PAWP, EVLWI, IL-6 and SP-D levelsdecreased more obviously in the liquid management group than those in the control group（P〈0.05）. The oxygen partial pressure of arterial blood gas increased more obviously in the liquid management group than in the control group（P〈0.05）. The improvement of lung function was greater in the liquid management group than in the control group（P〈0.05）. Conclusion： Low volume loadcouldeffectively protect pulmonary dysfunction of ARDS patients with injury,which was connected with the reduction ofinflammation and improvement of oxygen-consuming.

关 键 词：急性呼吸窘迫综合症 液体控制 肺功能 白细胞介素-6 肺泡表面活性蛋白D 

分 类 号：R641[医药卫生—外科学]