控制性肺膨胀对腹部手术后ARDS患者呼吸功能的影响  

Clinical study of sustained inflation on patients with ARDS after abdominal operation

作　　者：杜文杰[1] 赵李侠[1] 孙杰[1] 宋克义[1] 

机构地区：[1]安徽省亳州市人民医院重症医学科,236800

出　　处：《中华全科医学》2015年第6期931-933,共3页Chinese Journal of General Practice

摘　　要：目的探讨控制性肺膨胀（sustained inflation,SI）对于腹部手术后急性呼吸窘迫综合征（Acute Respiratory Distress Syndrome,ARDS）患者呼吸功能的影响。方法采用前瞻性随机对照研究方法,选取入住亳州市人民医院ICU的腹部手术后并发ARDS患者共40例,随机分为对照组（20例）和治疗组（20例）。入组后所有患者均需气管插管,取仰卧位,均予适当镇痛镇静,维持Ramsay评分3-4分,对照组以6 ml/kg的小潮气量通气和最佳呼气末正压（PEEP）的方法进行机械通气治疗,平台压≤30 cm H2O。治疗组在对照组的基础上给予SI,即在机械通气时采用持续气道正压的方式,设置正压水平30 cm H2O,持续30 s,然后调整到常规通气模式。观察SI前和SI后2 h、4 h的氧合指数、动脉血二氧化碳分压以及血流动力学指标变化,并进行统计分析。结果治疗组与对照组相比,SI后2 h、4 h的氧合指数分别为（205.5±36.7）mm Hg和（218.4±57.9）mm Hg,较前均明显改善（P〈0.05）,动脉血二氧化碳分压无明显降低（P〉0.05）。结论 SI能改善腹部手术后ARDS患者呼吸功能。Objective To investigate the effects of sustained inflation（SI） on the respiratory function in patients with a- cute respiratory distress syndrome （ARDS） after abdominal surgery. Methods A prospective randomized controlled study was designed. A total of 40 cases of ARDS after abdominal surgery in ICU of our hospital were enrolled and randomly di- vided into control group and treatment group with 20 cases in each group. All the patients in prone position received intu- bation after duly analgesic sedation. Ramsay score of 3 - 4 points was maintained during the ventilation. Both groups re- ceived low tidal volume ventilation（6 ml/kg）, the best positive end-expiratory pressure（PEEP）, and the pressure not more than 30 cm H20. Besides, the treatment group had their lungs ventilated with a 30 cm H20 SI maintained for 30 sec- onds, then turn to the former. Oxygen index, PaCO2, heart rate and mean arterial pressure were observed before and 2 h or 4h after SI. Results Compared with that in control group, the oxygenation index in treatment group was significantly im- proved（ P 〈 0.05 ）. But the difference in PaC02 was not significant （ P 〉 0.05 ）. Conclusion The sustained inflation can improve the respiratory function in the patients with ARDS after abdominal surgery.

关 键 词：控制性肺膨胀 急性呼吸窘迫综合征 ARDS 腹部手术后 呼吸功能 SI 

分 类 号：R563.8[医药卫生—呼吸系统]