文档介绍：肺复张手法治疗急性呼吸窘迫综合征患者的临床研究
中文摘要
目的:探讨肺复张策略(RM) 同小潮气量通气模式相结合对急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者的肺复张作用及其对血流动力学的影响。
方法: 2010年11月至2011年10月之间因各种因素导致ALI/ARDS入住ICU的病人14例,入住ICU后以小潮气量(6-8ml/kg)基础通气1小时后进行RM共计20次, 应用压力控制法(PCV)25cmH20,呼气末正压(PEEP)20cmH2O保持1分钟,观察RM前、 RM后15分、RM后1小时、RM后2小时动脉血气指标、血流动力学指标以及呼吸力学指标。
结果:与复张前比较,复张后动脉血气分析、动脉氧分压及氧合指数均有提高,15min、1 h、2 h 提高有统计学意义( P < ) ;二氧化碳分压、PH值无明显变化( P > ) ;气道峰压、平均气道压在肺复张后1h、2h明显升高( P < ) ,呼吸系统顺应性和平台压在复张后明显提高( P < ) ;中心静脉压、心率在复张过程中提高( P < ) ,心排量、平均动脉压复张过程中下降,但复张后15min及以后与治疗前比较没有明显变化( P > ) 。
结论:在肺保护性通气策略的基础上应用肺复张手法可以改善ARDS患者的氧合、提高肺的顺应性、对血流动力学的影响短暂。
关键词:急性呼吸窘迫综合征肺复张手法
The study on effects of Lung Recruitment Maneuvers in
Patients with Acute Respiratory Distress Syndrome
Abstract
objective: To investigate the clinical effects and safety of recruitment maneuvers (RM) combined with lung protective strategy in patient s with acute respiratory distress syndrome (ARDS).
Methods:Twenty acute respiratory distress syndrome(ARDS) patients caused by multiple diseases in intensive care unit(ICU)were enrolled in this study from November 2010 to October ventilated patients with ARDS underwent RM using a pressure of 45 cmH2O for 60s ,without any neuromuscular blocking agent.
Results :After RM treatment ,both oxygenation index and partial pressure of arterial oxygen(PaO2) were significantly increased in 15min 、1 hr and 2 hr ( P < ) . There was no significant difference in the partial pressure of carbon dioxide (PaCO2 ) and PH value before and after RM( P > ).The peak inspiratory pressures (PIP) and mean airway pressure(Pm)had no significant difference between after and before RM( P > ) , but respiratory pliance (Crs) and plateau inspiratory pressure increased markedly after RM ( P < ) .The central vein pressure (CVP) and heart rate(HR) increased during
recruitment ( P <) ,The cardiac output and mean arterial pressure (MAP) decrease during recruitment ( P <) ,but there was no
significant diff