床旁超声导向的最佳PEEP对ARDS患者氧合及血流动力学的影响  

The effects of he best PEEP by bedside ultrasound on oxygenation and hemodynamics in ARDS patients

作　　者：苏勇[1] 李寒春[2] 

机构地区：[1]四川省宜宾市第一人民医院急诊科,四川宜宾644000 [2]四川省宜宾市第一人民医院呼吸科,四川宜宾644000

出　　处：《临床和实验医学杂志》2016年第13期1260-1262,共3页Journal of Clinical and Experimental Medicine

基　　金：宜宾市科技局科研课题(2013YZY004)

摘　　要：目的探讨床旁超声导向的最佳呼气末正压(PEEP)对急性呼吸窘迫综合征(ARDS)患者氧合及血流动力学的影响。方法将ICU病房中22例ARDS患者根据肺复张(RM)后PEEP设置方法的不同分为分为床旁超声组(A组)和最大氧合法组(B组),各11例。对两组持续监测心电图并记录血流动力学指标[平均动脉血压(MAP),心率(HR),中心静脉压(CVP)];行血气分析测定p H、动脉血氧分压(PaO_2)和吸入氧气分压(FiO_2),并计算氧合指数(PaO_2/FiO_2);通过呼吸机监测并记录呼气末正压(PEEP)、潮气量(VT)和气道峰压(Ppeak)并计算动态顺应性(Cdyn)。比较两组RM前,RM后15 min、1 h、2 h时的PaO_2/FiO_2、Cdyn和血流动力学指标。结果两组Cdyn和PaO_2/FiO_2在RM后15 min、1 h和2 h均高于RM前(P<0.05);A组Cdyn和PaO_2/FiO_2RM后15 min、1 h和2 h均高于B组(P<0.05);两组HR、MAP和CVP在RM前比较差异无统计学意义(P>0.05);两组在RM后15 min CVP、HR高于RM前,MAP低于RM前(P<0.05);两组HR和MAP在RM后1 h、2 h和RM前比较差异无统计学意义(P>0.05);A组CVP在RM后1 h高于RM前(P<0.05);A组CVP在RM后2 h与RM前比较,差异无统计学意义(P>0.05);A组CVP在RM后15 min高于B组(P<0.05);两组CVP在RM后1 h、2 h比较差异无统计学意义(P>0.05)。结论 RM后床旁超声设置的最佳PEEP值可以更明显改善氧合和呼吸系统顺应性,对血流动力学无严重的不良影响。Objective To explore The effects of the best PEEP by bedside ultrasound on oxygenation and hemodynamics in ARDS pa-tients. Methods According to the lung recruitment（RM）after PEEP setting methods,22 patients with ARDS were randomly divided into bed-side ultrasound group（A group）and oxygenation group（B group）with 11 cases in each group. Continuous monitoring of ECG and hemodynamic parameters（MAP,HR,CVP）were recorded. Arterial blood gas analysis was performed to determine pH,arterial partial pressure of oxygen （PaO2 ）and oxygen fraction of FiO2 ,and calculated the oxygenation index（PaO2 / FiO2 ）. Through the ventilator monitoring,end expiratory posi-tive pressure（PEEP）,tidal volume（VT）and peak airway pressure（ ppeak）and calculation of dynamic compliance（ cdyn）were recorded. PaO2 / FiO2 ,Cdyn and hemodynamic parameters at before RM and after RM（at 15 min,1 h and 2 h）were compared in the two groups. Results The PaO2 / FiO2 and Cdyn after RM 15 min,1 h and 2 h were higher than before RM in two groups（ P 〈 0. 05）. The PaO2 / FiO2 and Cdyn of A groups was higher than B groups（ P 〈 0. 05）. The HR,MAP and CVP were no significance before RM in two groups（ P 〉 0. 05）. The HR and CVP were higher than before RM,MAP was higher than before RM in two groups（ P 〉 0. 05）. The HR and MAP CVP were no significance after RM 1h and 2h in two groups（ P 〉 0. 05）. The CVP after RM 15min was higher than before RM in A group（ P 〈 0. 05）. The CVP was no significance after RM 1h and 2h in A group（ P 〉 0. 05）. The A group CVP after RM 15min was higher than B groups（ P 〈 0. 05）. The CVP was no significance after RM 1h and 2h in two groups（ P 〉 0. 05）. Conclusion The best PEEP by bedside ultrasound improves oxygenation and compiiance of the respiratory system and has no obvious adverse effect on hemodynamics.

关 键 词：急性呼吸窘迫综合征 呼气末正压 肺复张 肺部超声 

分 类 号：R563.8[医药卫生—呼吸系统]