基于功能残气量导向对ARDS最佳呼气末正压选择的临床分析  

Clinical Analysis on the Optimal End-expiratory Pressure Selection for ARDS Based on Functional Residual Capacity

作　　者：刘静 储蕴 郭闯 付海燕 Liu Jing;Chu Yun;Guo Chuang;Fu Haiyan(The First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000 China)

机构地区：[1]锦州医科大学附属第一医院,辽宁锦州121000

出　　处：《锦州医科大学学报》2022年第3期80-83,共4页Journal of Jinzhou Medical University

基　　金：辽宁省科学技术厅重点研发计划项目,项目编号:2020JH/10100017。

摘　　要：目的观察基于功能残气量(functional residual capacity,FRC)导向对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者选择最佳呼气末正压(positive end expiratory pressure,PEEP)的临床效果。方法选择2020年5月至2020年11月入住锦州医科大学附属第一医院重症医学科一、二病区的ARDS患者49例,将患者随机分为观察组与对照组,两组患者充分镇静后均采用PEEP递增法进行肺复张,其中观察组通过监测FRC设置最佳PEEP,对照组则采用最大氧合法设置最佳PEEP。比较两组患者在肺复张后30 min、2 h的氧合指数、动态顺应性(Cdyn)、脉搏氧饱和度(SpO_(2))。结果观察组患者在肺复张后设置的最佳PEEP为(16.30±1.66),对照组患者在肺复张后设置的最佳PEEP为(14.69±1.52),结果观察组明显高于对照组,差异具有统计学意义(P<0.05)。观察组肺复张后30 min的氧合指数、Cdyn、SpO_(2)分别为(330.13±21.69)、(47.87±3.27)、(97.39±1.56),对照组肺复张后30 min的氧合指数、Cdyn、SpO_(2)分别为(310.42±18.77)、(45.81±2.88)、(96.27±1.37),差异具有统计学意义(P<0.05);观察组肺复张后2 h的氧合指数、Cdyn、SpO_(2)分别为(285.61±9.82)、(45.83±2.42)、(95.35±1.53),对照组肺复张后2 h的氧合指数、Cdyn、SpO_(2)分别为(274.77±12.62)、(44.77±2.02)、(94.42±0.89),差异具有统计学意义(P<0.05)。结论ARDS患者在肺复张时监测FRC可指导选择最佳PEEP,并且改善患者的氧合指数、Cdyn、SpO_(2)。Objective To observe the clinical effect of optimal positive end-expiratory pressure(PEEP)in patients with acute respiratory distress syndrome(ARDS)based on functional residual capacity guidance.Methods 49 ARDS patients admitted to ICU 1 and ICU 2 of the First Affiliated Hospital of Jinzhou Medical University from May 2020 to November 2020 were randomly divided into observation group and control group.After full sedation,patients in both groups were treated with the incremental PEEP method for lung extension.Optimal PEEP was set by monitoring FRC in the observation group,and optimal PEEP was set by maximum oxygen method in the control group.The oxygenation index,dynamic compliance(Cdyn)and pulse oxygen saturation(SpO_(2)) were compared between the two groups at 30 min and 2 h after pulmonary recruitment.Results The optimal PEEP of the observation group was 16.30±1.66 and that of the control group was 14.69±1.52,respectively,which was significantly higher in the observation group than in the control group,with statistical significance(P<0.05).The oxygenation index,Cdyn and SpO_(2) of the observation group were 330.13±21.69,47.87±3.27 and 97.39±1.56,respectively,30 min after lung reopening.The oxygenation index,Cdyn and SpO_(2) of the control group were 310.42±18.77,45.81±2.88 and 96.27±1.37,respectively,with statistical significance(P<0.05).The oxygenation index,Cdyn and SpO_(2) of the observation group were 285.61±9.82,45.83±2.42 and 95.35±1.53,respectively,at 2h after pulmonary recruitment.The oxygenation index,Cdyn and SpO_(2) of the control group were 274.77±12.62,44.77±2.02 and 94.42±0.89,respectively,with statistical significance(P<0.05).Conclusion Monitoring FRC in ARDS patients during pulmonary recruitment can guide the selection of optimal PEEP and improve patients'oxygenation index,Cdyn and SpO_(2).

关 键 词：功能残气量 急性呼吸窘迫综合征 呼气末正压 肺复张 

分 类 号：R563.8[医药卫生—呼吸系统]