不同压力控制性肺膨胀对急性呼吸窘迫综合征患者吸痰后肺复张的影响

摘要

目的：探讨不同压力控制性肺膨胀(SI)对急性呼吸窘迫综合征(ARDS)患者吸痰后肺复张的影响。方法选取重庆三峡医院急救ICU科2012年9月～2014年1月的ARDS患者40例，随机分为P0、P1、P2、P3、P4组，每组各8例，分别采用0、30、35、40、45 cm H2O(1 cm H2O=0.098 kPa)压力进行肺复张。记录患者吸痰后SI肺复张的呼吸力学指标及血流动力学指标。结果①P1、P2、P3、P4组肺复张后肺容积、肺动态顺应性(Cd)值明显高于P0组，差异有统计学意义(P<0.05)；P1、P2、P3、P4组肺复张后肺复张后气道峰压(PIP)、气道平均压(Pm)、气道平台压(Pplat)明显低于P0组，差异有统计学意义(P<0.05)；P1～P4组间差异无统计学意义(P>0.05)。于P1、P2、P3、P4组实施SI后其平均动脉血压(MAP)、平均肺动脉压(PAP)、中心静脉压(CVP)与P0比较，差异无统计学意义(P>0.05)。 P3、P4组心率(HR)分别与P1、P2、P3组比较，差异有统计学意义(P<0.05)。结论30、35 cm H2O为实施SI治疗ARDS患者的适合压力。%Objective To investigate the effects of different pressures sustained inflation (SI) on patients with acute res-piratory distress syndrome (ARDS) after lung recruitment of suction. Methods 40 cases of ARDS from September 2012 to January 2014 in Department of Emergency Intensive Care Unit, Chongqing Three Gorges Central Hospital were en-rolled and randomly divided into group P0, group P1, group P2, group P3, group P4, with 8 cases in each group and treated with 0, 30, 35, 40, 45 cm H2O pressure (1 cm H2O=0.098 kPa) for lung recruitment respectively. The patient's respiratory mechanics and hemodynamic index after SI lung recruitment of suction were recorded. Results ①The lung volume after lung recruitment, lung dynamic compliance (Cd) of group P1, group P2, group P3, group P4 were all high-er than those of group P0, the differences were statistically significant (P<0.05); the peak airway pressure (PIP), mean airway pressure (Pm), airway plateau pressure (Pplat) after lung recruitment of group P1, group P2, group P3, group P4 were all lower than those of group P0, the differences were statistically significant (P<0.05). There was no significant difference among group P1-P4.②The differences of mean arterial blood pressure (MAP), mean pulmonary artery pres-sure (PAP), central venous pressure (CVP) after SI between group P1, group P2, group P3, group P4 and group P0 was not statistically significant (P > 0.05). The differences of HR between group P3, group P4 and group P1, group P2, group P3 were all statistically significant (P<0.05). Conclusion 30 and 35 cm H2O are suitable pressure in the treat-ment of ARDS in patients with SI.