气道压力释放通气应用于急性肺损伤/急性呼吸窘迫综合征患者的研究  

Clinical research about airway pressure release ventilation for acute lung injury/acute respiratory distress syndrome

作　　者：宋邵华[1] 田惠玉[1] 杨秀芬[1] 胡振杰[2] 

机构地区：[1]河北医科大学第一医院重症医学科,河北石家庄050031 [2]河北医科大学第四医院重症医学科,河北石家庄050021

出　　处：《临床肺科杂志》2016年第5期802-805,共4页Journal of Clinical Pulmonary Medicine

基　　金：河北省2011年医学科学研究重点课题(No 20110305)

摘　　要：目的评价气道压力释放通气(airway pressure release ventilation,APRV)对急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的疗效,评估其对患者呼吸机相关性肺损伤(Ventilator-Induced Lung Injury,VILI)程度,并探讨可能的机制。方法采用前瞻性研究方法,入组患者随机分为APRV组、小潮气量肺保护通气组。描记肺准静态压力-容积曲线(pressure-volume curve,P-V曲线),并据此设置呼吸机参数,通气24h、48h观察效果。结果两组患者氧合明显改善,血流动力学指标无明显变化,APRV组Pmean明显高于SIMV+PEEP组,准静态P-V曲线三角区Pflex容积(Vdelta)增加明显,血清SP-D浓度呈升高趋势。结论 APRV应用于急性肺损伤/急性呼吸窘迫综合征患者,相对于小潮气量肺保护性通气策略,氧合改善、呼吸力学类似;较高的平均气道压,能更有效地肺复张,未对血流动力学产生影响,但加重了肺损伤,导致呼吸机相关性肺损伤。Objective To evaluate the curative effect of airway pressure release ventilation （APRV） for acute lung injury/acute respiratory distress syndrome, and to evaluate its effect and possible mechanism of ventilatorinduced lung injury. Methods The patients in ICU with ALI/ARDS were randomly divided into two groups. The APRV group was given airway pressure release ventilation, and the control group was given lung protection ventilation with lower tidal volume. The mechanical ventilation parameters were detected based on the quasistatic P-V curve 24 and 48 hours after ventilation. Results 24 and 48 hours after mechanical ventilation, their oxygenation improved significantly in the two groups, but there was no significant change in hemodynamic parameters. The value of Pmean in the APRV group was higher than that in the control group. In the APRV group, the value of Vdelta increased obvi- ously. The SP-D density in blood serum in the APRV group had the tendency of increase. Conclusion With lung protective ventilation strategy, airway pressure release ventilation is similar in oxygenation and lung mechanical parameters. The higher Pmean pressure of APRV could recruit alveolar more effectively, which has no impact on blood stream dynamics, but the higher Pmean pressure has caused ventilator-induced lung injury.

关 键 词：气道压力释放通气 氧合 呼吸机相关性肺损伤 

分 类 号：R563.8[医药卫生—呼吸系统]