严重脓毒症患者高呼气末正压肺复张对其呼吸力学和血流动力学的影响  

Effect of positive end expiratory pressure on hemodynamics and hemodynamics in patients with severe sepsis after inhalation

作　　者：张爱园 黄中伟[2] ZHANG Ai-yuan;WANG Zhong-wei(Department of Intensive Medicine,Haian People's Hospital,Nantong,Jiangsu226600,China)

机构地区：[1]海安市人民医院重症医学科,江苏南通226600 [2]南通大学附属医院急诊室,江苏南通226001

出　　处：《临床肺科杂志》2019年第6期988-991,共4页Journal of Clinical Pulmonary Medicine

基　　金：南通市科技项目(No MS32015032)

摘　　要：目的分析严重脓毒症患者实施吸痰后高呼气末正压肺复张对其呼吸力学和血流动力学的影响。方法选取我院在2016年4月至2018年6月收治的104例严重脓毒症伴有Ⅰ型呼吸衰竭患者。借助数字表作为随机分组依据,将纳入对象划分为研究组和对照组,每组各52例。研究组应先应用压力控制通气(PCV)模式,再应用容量控制通气(VCV)模式。对照组则先应用容量控制通气(VCV)模式,再应用压力控制通气(PCV)模式。比较不同时间点的心率、平均动脉压(MAP)、潮气量、气道峰压(Ppeak)、PPlat值。结果不论是PVC模式,还是VCV模式,患者在肺复张前的心率和MAP值均高于基础数值(P<0.05);在肺复张后1min和3min时的心率值较肺复张前增加,而MAP值则低于肺复张前(P<0.05)。不论是PVC模式,还是VCV模式,患者在肺复张前的潮气量、Crs均小于基础水平数值,Ppeak、PPlat值均高于基础水平数值;肺复张后1、3、5、10、30min的潮气量、Crs、Ppeak、PPlat值较肺复张前数值差异均有统计学意义(P<0.05)。结论吸痰后高呼气末正压肺复张应用于严重脓毒症患者,能提高患者的肺功能,且能使血流动力学区域稳定。Objective To investigate the effect of positive end-expiratory pressure on respiratory and hemodynamics in patients with severe sepsis after sputum aspiration.Methods 104 patients with severe sepsis complicated with type I respiratory failure admitted to our hospital from April 2016 to June 2018 were selected.The subjects were divided into the study group and the control group,52 cases in each group.The study group first adopted pressure-controlled ventilation(PCV)mode,and then volume-controlled ventilation(VCV)mode.The ventilation pattern of the control group was opposite to that of the control group.Heart rate,mean arterial pressure(MAP),tidal volume,peak airway pressure(PPEAR)and plat were compared between the two groups at different time points.Results There was a significant difference in the rate of pastry and MAP in PCV patients at different time points(P<0.05).Heart rate and MAP increased before(or after sputum aspiration),increased one minute after lung resuscitation,and decreased three minutes after lung resuscitation.The heart rate increased significantly before lung resuscitation,and the difference was statistically significant(P<0.05).Under the mechanical ventilation mode of PCV,the tidal volume before resuscitation was lower than the basal level,and the tidal volume and CRS value increased 1 minute after resuscitation(P<0.05).Under VCV mechanical ventilation,PSPAR and platinum levels were higher than baseline levels,while CRS levels were lower than baseline levels(P<0.05).Conclusion Positive end-expiratory pressure ventilation after sputum aspiration can improve lung function and stabilize hemodynamics in patients with severe sepsis.

关 键 词：脓毒症 吸痰 高呼气末正压通气 肺复张 呼吸力学 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]