呼吸末正压递增肺复张法在急性主动脉夹层术后低氧血症的临床应用分析  

Clinical application of incremental positive end expiratory pressure in lung recruitment maneuver for post-operative hypoxia in aortic dissection patients

作　　者：李小密[1] 刘楠[1] 侯晓彤[1] 孙立忠[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科危重症中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2016年第9期741-744,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评价间歇应用高呼吸末正压递增的肺复张法,对急性主动脉夹层术后低氧血症的改善作用及对机械通气的影响,同时对其安全性进行评价。方法:前瞻性随机对照研究。入选2014年2月至2014年12月间,急性主动脉夹层术后出现低氧血症(氧和指数≤200mm Hg,1mm Hg=0.133k Pa)的机械通气患者38例,随机分为两组:对照组(n=19),应用常规机械通气治疗;试验组(n=19),间歇行高呼吸末正压(PEEP)递增的肺复张法治疗。对比两组患者肺复张前后呼吸系统和循环系统各参数的变化,以及机械通气时间、ICU治疗时间和住院时间。结果:1例试验组患者肺复张过程中出现气胸,此患者为排除病例,余患者肺复张过程顺利,完成试验。两组氧和指数在治疗后,试验组明显高于对照组,差异有统计学意义(P<0.05);对照组和试验组PH值在治疗前后,差异有统计学意义(P<0.05);对照组和试验组二氧化碳分压在治疗前后,都不存在显著差异;对照组和试验组肺顺应性在治疗前没有显著差异,而在治疗后,试验组肺顺应性明显提高,两组之间差异有统计学意义(P<0.05);在循环系统,对照组和试验组在治疗前后心率、中心静脉压没有显著差异,平均动脉压差异有统计学意义(P<0.05)。胸X线片评分方面,对照组和试验组分别在治疗前后差异有统计学意义(P<0.05)。对照组与试验组机械通气时间、ICU时间、住院时间差异无统计学意义。结论:急性主动脉夹层术后低氧血症目前很多见,呼吸末正压递增的肺复张法能够有效地纠正急性主动脉夹层术后的低氧血症,明显的改善氧和状态,在严密的监测血流动力学变化的情况下,是安全有效地。Objective：This article aims to evaluate the effects of intermittent incremental positive end expiratory pressure（PEEP） in lung recruitment maneuver for post-operative hypoxia in aortic dissection patients and how it will affect mechanical ventilation together with its safety. Methods： A prospective randomized controlled study was performed in 38 aortic dissection patients who suffered post-operative hypoxia during mechani- cal ventilation （oxygenation index ≤ 200mmHg, l mmHg = 0. 133kPa）. Patients were randomly divided into 2 groups： Control group（ n = 19） patients were treated with normal mechanical ventilation, while PEEP group （n = 19） patients were treated with intermittent lung recruitment by incremental PEEP. Parameters of respiratory and circulatory system before and after lung recruitmentmaneuver, mechanical ventilation duration, ICU stay and hospital stay were collected, compared and analyzed. Results： Pneumothorax occurred in one of the patients in PEEP group, no complication occurred in the rest of the patients. There were no significant difference in sex, age, weight and BMI between the 2 groups. In respiratory system, before lung recruitment maneuver,no significant difference was shown in oxygen index and lung compliance, while it was shown after lung recruit- mentmaneuver（P 〈0. 05）. Significant differences were shown in PH and no difference occmTed in Pco2 before and after treatment（P 〈 0. 05 ）. In circulatory system, no significant difference occurred in heart rate and cen- tral venous pressure before and after the intervention, but mean blood pressure was significant difference （ P 〈 0. 05 ）. In chest X-ray scoring, the scores were different before and after normal mechanical ventilation or incremental PEEP lung recruitment maneuver, which is statistically significant（ P 〈 0. 05 ）. No significant difference were found in mechanical ventilation duration, ICU stay and hospital stay. Conclusion：Post-operative hypoxia is common in acute aortic dissec

关 键 词：呼吸末正压 肺复张 急性主动脉夹层 低氧血症 

分 类 号：R56[医药卫生—呼吸系统]