控制性肺膨胀压力变化对急性呼吸窘迫综合征患者不同负压吸痰后肺复张的影响  

Effect of sustained inflation with different degrees of negative pressure for sputum aspiration in patients with acute respiratory distress syndrome on lung recruitment

作　　者：黄霞[1] 崔吉文[1] 

机构地区：[1]重庆三峡中心医院急救ICU,重庆万州404000

出　　处：《中华危重病急救医学》2015年第7期606-610,共5页Chinese Critical Care Medicine

基　　金：重庆市医药卫生科研计划项目（2012-2-272）

摘　　要：目的：探讨不同压力的控制性肺膨胀（SI）对急性呼吸窘迫综合征（ARDS）患者不同负压吸痰后肺复张的影响。方法前瞻性单盲随机对照研究设计，采用析因方差分析法，选择2012年1月至2014年12月重庆三峡中心医院急救重症加强治疗病房（ICU）收治的ARDS患者150例，按随机数字表法将其分为S1、S2、S3组，每组50例，分别应用150、175、200 mmHg（1 mmHg＝0.133 kPa）负压吸痰；然后每组再随机分为P0、P1、P2、P3、P4亚组，每组10例，分别采用0、30、35、40、45 cmH2O（1 cmH2O＝0.098 kPa）复张压力进行SI。记录并比较吸痰前后以及进行肺复张后患者的呼吸力学指标及血流动力学指标。结果150例患者吸痰后肺复张容积（mL：87.56±28.47比109.38±34.63，t＝3.573，P＝0.001）和肺静态顺应性〔Cst（mL/cmH2O）：27.69±13.25比35.87±17.47，t＝2.814，P＝0.004〕较吸痰前显著降低，气道峰压〔PIP（cmH2O）：24.16±8.28比18.63±6.67，t＝2.957，P＝0.005〕、气道平台压〔Pplat（cmH2O）：21.28±9.14比17.47±7.26，t＝2.089， P＝0.032〕、气道平均压〔Pm（cmH2O）：13.26±4.65比10.41±3.54，t＝3.271，P＝0.001〕较吸痰前明显升高。肺复张容积、Cst、PIP、Pplat、Pm在不同吸痰负压间差异无统计学意义（F值分别为0.809、0.986、1.121、0.910、1.043，P值分别为0.452、0.381、0.335、0.410、0.361），在不同肺复张压力间差异有统计学意义（F值分别为3.581、5.028、3.064、3.036、4.050，P值分别为0.013、0.002、0.026、0.027、0.007），且两因素不存在交互作用。两两比较后发现，在相同吸痰负压条件下，不同复张压力亚组（P1、P2、P3、P4）肺复张容积、Cst均明显高于其P0亚组，PIP、Pplat、Pm均明显低于P0亚组；而P1、P2、P3、P4亚组间差异无统计学意义。平均动脉压（MAP）、肺动脉压（PAP）在不同吸痰负压及不同肺复张压力间差异均无统计学意义（吸ObjectiveTo investigate the effect of different degrees of pressure of sustained inflation （SI） in patients with acute respiratory distress syndrome （ARDS） after lung recruitment as the result of different negative pressure for sputum aspiration.Methods A prospective single-blind randomized controlled trial was conducted. The factorial analysis of variance was adopted. 150 patients with ARDS admitted to the emergency intensive care unit （ICU） of Chongqing Three Gorges Central Hospital from January 2012 to December 2014 were enrolled, and they were randomly divided into S1, S2, S3 group, with 50 patients in each group, suction pressure varying from 150, 175, to 200 mmHg （1 mmHg = 0.133 kPa） was respectively used in each group. Then the patients of each group were randomly subdivided into five subgroups of P0, P1, P2, P3, P4, with 10 patients in each group, and 0, 30, 35, 40, and 45 cmH2O （1 cmH2O = 0.098 kPa） were used for control pulmonary inflation pressure, respectively. The respiratory mechanics and the hemodynamic parameters were recorded, and they were compared before and after the sputum aspiration as well as lung recruitment with sustained inflation.Results The lung recruitment volume （mL： 87.56±28.47 vs. 109.38±34.63 t = 3.573,P = 0.001） and lung static compliance [Cst （ mL/cmH2O）： 27.69±13.25 vs. 35.87±17.47,t = 2.814,P = 0.004] after sputum aspiration in the 150 patients were significantly lower than those before the sputum aspiration, and peak airway pressure [PIP （cmH2O）： 24.16±8.28 vs. 18.63±6.67,t = 2.957,P = 0.005], airway plateau pressure [Pplat （cmH2O）： 21.28±9.14 vs. 17.47±7.26,t = 2.089,P = 0.032], and mean airway pressure [Pm （cmH2O）： 13.26±4.65 vs. 10.41±3.54,t = 3.271,P = 0.001] were significantly higher than those before the treatment. There were no significant differences in the lung recruitment volume, Cst, PIP, Pplat and Pm between groups with different negative pressure for sputum aspiration （F value was 0.809, 0.986, 1.121,

关 键 词：控制性肺膨胀 急性呼吸窘迫综合征 吸痰 肺复张 

分 类 号：R563.8[医药卫生—呼吸系统]