重症胰腺炎腹腔高压合并ARDS机械通气呼吸机参数设置对患者气体交换、呼吸力学的影响  

Effects of Ventilator Parameters on Gas Exchange and Respiratory Mechanics in Patients with Severe Acute Pancreatitis Complicated with Intra-abdominal Hypertension and ARDS Mechanical Ventilation

作　　者：蔡长霞 甘桂芬[1] 牛毅[1] 赵海燕[1] CAI Changxia;GAN Guifen;NIU Yi;ZHAO Haiyan(Department of Critical Care Medicine,Affiliated Hospital of Qinghai University,Xining 810000,China)

机构地区：[1]青海大学附属医院重症医学科,西宁810000

出　　处：《解放军预防医学杂志》2018年第6期754-757,共4页Journal of Preventive Medicine of Chinese People's Liberation Army

摘　　要：目的分析应用跨肺压指导重症胰腺炎腹腔高压合并ARDS机械通气患者呼吸机参数设置对患者气体交换、呼吸力学的影响。方法选取我院2015年6月至2017年6月25例重症胰腺炎腹腔高压合并ARDS机械通气患者作为研究对象,并检测跨肺压,维持吸气末跨肺压小于24 cm H2O,设置呼气末正压并维持呼气末跨肺压于0~10 cm H2O。观察25例患者的气体交换和呼吸力学的变化。结果腹腔压力与气道平台压呈正相关(P<0.05),与胸壁顺应性呈负相关(P<0.05),与吸气末跨肺压及呼气末跨肺压无明显相关性(P>0.05)。根据跨肺压设置呼吸机参数,25例患者呼气末正压和呼气末跨肺压显著高于基础值(P<0.05),吸气末跨肺压与基础值比较无显著变化(P>0.05);呼气末跨肺压与呼气末正压、呼气末食道压显著相关(P<0.05);吸气末跨肺压与气道平台压、吸气末食道压显著相关(P<0.05),与潮气量无显著差异(P>0.05);肺静态顺应性显著高于基础值(P<0.05);呼吸系统及胸壁顺应性与基础值比较无显著变化(P>0.05);氧合指数显著高于基础值(P<0.05);死腔分数显著低于基础值(P<0.05)。结论应用跨肺压指导重症胰腺炎腹腔高压合并ARDS机械通气患者呼吸机参数设置,有利于改善肺顺应性、氧合指数、塌陷肺泡复张,降低死腔通气值,同时通过监测肺应力避免肺泡过度膨胀,从而保护肺的功能。Objective To analyze the effects of the transpulmonary pressure on gas exchange and respiratory mechanics inpatients with severe pancreatitis complicated with intra - abdominal hypertention combined with ARDS mechanical ventilation.Methods Twenty-five patients with severe acute pancreatitis with intra-abdominal hypertention combined with ARDS mechanicalventilation who were treated between June 2015 and June 2017 were selected as the subjects, whose transpulmonary pressure wasdetected. The end-inspiratory transpulmonary pressure was less than 24 cmH2O. The positive end-expiratory pressure was setand the end-expiratory transpulmonary pressure was maintained at 0 to 10 cmH2O. The changes of gas exchange and respiratorymechanics in these patients were observed. Results The intra-abdominal pressure was positively correlated with the airway pres-sure （P〈0. 05）, but negatively correlated with the compliance of the chest wall （P〈0. 05）, and had no significant correlationwith the end-inspiratory transpulmonary pressure or the end-expiratory transpulmonary pressure （P〉0. 05）. According to theparameters of the ventilator, the positive end-expiratory pressure and the end-expiratory transpulmonary pressure of these 25 pa-tients were significantly higher than the baseline value （ P〈0. 05 ）. There was no significant change in the end - inspiratorytranspulmonary pressure and the baseline value （P〉0. 05）. There was no significant difference （P〈0. 05） between the platformpressure and end-inspiratory esophagus pressure （P〉0. 05）. The static compliance of the lung was significantly better than thatof the baseline value （P〈0. 05）, but the compliance of the respiratory system and the chest wall was not significantly changed（P〉0. 05）. The oxygenation index was significantly higher than the baseline value （P〈0. 05）, and the dead space fraction wassignificantly lower than the baseline value （P〈0. 05）. Conclusion Using transpulmonary pressure to adjust the ventilator parame

关 键 词：跨肺压 重症胰腺炎 腹腔高压 急性呼吸窘迫综合征 呼吸机 

分 类 号：R576[医药卫生—消化系统]