纤维支气管镜术后肺复张在严重脓毒症合并Ⅰ型呼吸衰竭患者中的应用效果  

Application effect of lung recruitment after bronchofiberoscopy in patients with severe sepsis complicated with type Ⅰ respiratory failure

作　　者：李桂冰[1] 熊滨[1] 翰林 向淑麟[1] 庞静[1] 

机构地区：[1]广西壮族自治区人民医院重症医学科,南宁市530021

出　　处：《广西医学》2017年第7期967-970,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2015355;Z2013356)

摘　　要：目的探讨纤维支气管镜术后肺复张在严重脓毒症并Ⅰ型呼吸衰竭患者中的应用效果。方法将严重脓毒症并发Ⅰ型呼吸衰竭患者90例分为研究组和对照组,每组45例,两组均行机械通气及纤维支气管镜检查,研究组患者行纤维支气管镜后立即采用控制性肺膨胀法进行肺复张,对照组患者行纤维支气管镜后给予基础机械通气,观察两组患者纤维支气管镜检查前后、肺复张后(对照组为纤维支气管镜后)1 min、30 min、60 min血流动力学指标[HR、平均动脉压(MAP)]、血乳酸值、血气分析指标(pH、Pa O2、Pa CO2)及呼吸力学指标[潮气量、气道平台压(Pplat)、气道阻力(Raw)、静态顺应性(Cst)]的变化。结果 (1)两组Pa O2、Pa CO2及pH比较,差异均有统计学意义(均P<0.05),均有随时间变化的趋势,但研究组趋势更显著(均P<0.05),分组与时间均存在交互作用(均P<0.05)。(2)两组潮气量、Cst、Raw及Pplat比较,差异均有统计学意义(均P<0.05),均有随时间变化的趋势,但研究组趋势更显著(均P<0.05),分组与时间均存在交互作用(均P<0.05)。(3)两组HR、MAP及血乳酸水平比较,差异均有统计学意义(均P<0.05),均有随时间变化的趋势(均P<0.05),分组与时间均存在交互作用(均P<0.05)。结论纤维支气管镜检查后采用肺复张策略能改善脓毒症并Ⅰ型呼吸衰竭患者的呼吸力学指标,提高Pa O2,且对血流动力学影响较小。Objective To explore the application effect of lung recruitment after bronchofiberoscopy in patients with severe sepsis complicated with type Ⅰ respiratory failure. Methods Ninety patients with severe sepsis complicated with type Ⅰ respiratory failure were randomly divided into study group and control group,with 45 cases in each group. The patients in the two groups underwent mechanical ventilation and bronchofiberoscopy. After bronchofiberoscopy,the patients in the study group received lung recruitment using sustained inflation immediately while the patients in the control group underwent basic mechanical ventilation. Before and after bronchofiberoscopy,at one,30 and 60 minutes after lung recruitment（bronchofiberoscopy in the control group）,hemodynamics parameters[including HR and mean arterial pressure（MAP） ],lactic acid level,indices of blood gas analysis（pH,Pa O2 and Pa CO2） and respiratory mechanics parameters[tidal volume,plateau pressure（Pplat）,airway resistance（Raw）,static lung compliance（Cst） ]were observed in both groups. Results（1） Pa O2,Pa CO2 and pH showed significant differences between the two groups（all P〈0. 05） and changed over time,the change was more significant in the study group（all P〈0. 05）,and interaction effect was observed between group and time（all P〈0. 05）.（2） Tidal volume,Cst,Raw and Pplatshowed significant differences between the two groups（all P〈0. 05） and changed over time,the change was more significant in the study group（all P〈0. 05）,and interaction effect was observed between group and time（all P〈0. 05）.（3） HR,MAP and blood lactic acid level showed significant differences between the two groups（all P〈0. 05） and changed over time（all P〈0. 05）,and interaction effect was observed between group and time（all P〈0. 05）. Conclusion Lung recruitment strategy performed after bronchofiberoscopy can improve respiratory mechanics parameters and increase the Pa O2 level,but it has little influence on

关 键 词：脓毒症 呼吸衰竭 纤维支气管镜 机械通气 肺复张 呼吸力学 血流动力学 

分 类 号：R563.8[医药卫生—呼吸系统]