期刊文献+

肺复张治疗肺外源性急性呼吸窘迫综合征的效果评价 被引量:2

Effects of recruitment maneuvers in extrapulmonary acute respiratory distress syndrome
下载PDF
导出
摘要 目的观察肺复张对肺外源性急性呼吸窘迫综合征(ARDS)患者氧合指数[氧分压(PaO2)/吸入氧气浓度(FiO2)]、呼吸力学及血流动力学的影响。方法 14例肺外源性ARDS患者行保护性肺通气,稳定后开始肺复张治疗。实施控制性肺膨胀(SI)进行肺复张,每8小时进行1次,共3天,纪录每天第1次患者治疗前及治疗后1小时的血气指标、呼吸机参数及肺复张前后的血流动力学指标。结果 1、2、3天肺复张治疗后1小时患者PaO2/FiO2较治疗前均有上升,(162.6±19.80)mmHg vs(220.93±34.10)mmHg,(195.6±24.40)mmHg vs(243.3±34.60)mmHg,(222.57±27.40)mmHg vs(254.71±38.90)mmHg(P<0.05或<0.01);气道峰压[PIP:(35.64±2.71)cmH2O vs(34.07±2.58)cmH2O,(32.86±3.30)cmH2O vs(30.93±3.15)cmH2O,(30.14±2.66)cmH2O vs(28.07±3.27)cmH2O,P<0.01]、气道平台压[Pplat:(31.29±2.49)cmH2O vs(28.93±2.63)cmH2O,(28.79±3.02)cmH2O vs(26.86±3.13)cmH2O,(25.71±2.09)cmH2O vs(23.57±2.34)cmH2O,P<0.01]在肺复张治疗后均下降,呼吸系统静态顺应性(Cst)在肺复张治疗后改善,且整体呈升高趋势[(26.21±3.26)ml/cmH2O vs(30.14±3.70)ml/cmH2O,(29.36±4.25)ml/cmH2O vs(33.64±5.30)ml/cmH2O,(32.14±5.05)ml/cmH2O vs(35.57±5.57)ml/cmH2O,P<0.01)];14例患者中有9例在肺复张过程中心率升高、血压下降,但均能于复张后3分钟恢复至复张前水平,余患者肺复张过程中心率、血压未见明显波动,14例患者均无心律失常发生。结论对于肺外源性ARDS,肺复张可明显改善氧合,改善呼吸系统顺应性,对血流动力学影响轻微。 Objective To observe the influence of the recruitment maneuvers (RM) on the oxygenation index (PaO2/FiO2), respiratory mechanics, haemodynamics of the patients with extrapulmonary acute respiratory distress syndrome (ARDS). Methods Lung protective ventilation was implemented in 14 patients with extrapulmonary ARDS until they were in a steady state. Then' the sustained inflation (SI) was applied once every 8 hours for 3 days. The blood gas indices and ventilator parameters before the first SI and one hour after SI and the haemodynamics indices before and after SI were recorded every day. Results The oxygenation index (PaO2/FiO2 ) of the patients 1 hour after RM during 3 days rose,(162.64± 19.80)mmHg vs (220.93± 34.10) mmHg,(195.64± 24.40) mmHg vs (243.29±34.60) mmHg, (222.57±27.40) mmHg vs (254.71±38.90) mmHg( P (0.05). Both the peak inspiratory pressure (PIP),(35.64±2.71) cmH2O vs (34.07±2.58) cmH20,(32.86±3.30) cmH2O vs (30. 93±3.15) cmH2O,(30.14±2.66) cmH2O vs (28.07±3.27) cmH2O ( P 〈0.01) and the plateau pressure (Pplat), (31.29±2.49) cmH2O vs (28.93±2.63) cmH2O,(28.79±3.02) cmH2O vs (26.86±3.13) cmH20,(25.71±2.09)cmH20 vs (23.57± 2.34) cmH2O ( P d0.01) fell after the RM while the static compliance (Cst) of the respiratory system was improved after the RM and rose on the whole, (26.21±3.26) ml/cmH2O vs (30.14±3.70) ml/cmH2O, (29.36±4.25) ml/ cmH2O vs (33.64!5.30) ml/cmH2O,(32.14±5.05) ml/emH20 vs (35.57±5.57) ml/cmH2O ( P 〈0.01). 9 of the 14 patients had heart rate increase and blood pressure decrease in the course of the RM, but 3 minutes after the RM their heart rate and blood pressure returned to the level before RM. The rest patients had no obvious fluctuations in heart rate and blood pressure and all the 14 patients had no cardiac arrhythmia during RM. Conclusion In extrapulmonary ARDS, RM evidently improves the oxygenation and the static compliance (Cst) of the respiratory system and has slight influence on haemodynamics.
出处 《临床荟萃》 CAS 2012年第20期1772-1775,共4页 Clinical Focus
关键词 呼吸窘迫综合征 成人 呼吸 人工 呼吸力学 肺顺应性 血液动力学 respiratory distress syndrome, adult respiration, artificial respiratory mechanics lung compliance hemodynamic phenomena
  • 相关文献

参考文献10

  • 1Tugrul S, Akinci O, Ozcan PE, et al. Effects of sustained inflation and postinflation positive end-expiratory pressure in acute respiratory distress syndrome:focusing on pulmonary and extrapulmonary forms[J]. Crit Care Med, 2003,31 (3):738- 744.
  • 2Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference on ARDS. Definitions, mechanisms,relevant outcomes, and clinical trial coordination [J]. Am J Respir Crit Care Med,1994,149(3 pt 1) :818-824.
  • 3易丽,席修明.小潮气量通气加肺复张法对急性呼吸窘迫综合征疗效的影响[J].中国危重病急救医学,2005,17(8):472-476. 被引量:27
  • 4Bugedo G, Bruhn A, Hernandez G, et al. Lung computed tomogrpahy during a lung recruitment maneuver in patients with acute lung injury[J]. Intensive Care Med, 2003,29 (2) :218-225.
  • 5Constantin JM,Jaber S, Futier E, et al. Respiratory effects of different recruitment maneuvers in acute respiratory distress syndrome[J]. Crit Care, 2008, 12 (2) : R50.
  • 6Borges JB, Okamoto VN, Matos GF, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome[J]. Am J Respir Crit Care Med,2006,174 (3):268- 278.
  • 7Pelosi P, D' Onofrio D, Chiumello D, et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different[J]. Eur Respir J Suppl, 2003,42 (8), 48s-56 s.
  • 8Pierrakos C, Karanikolas M,Scolletta S, et al. Acute respiratory distress syndrome: pathophysiology and therapeutic options [J]. J Clin Med Res,2011,4(1) :7-16.
  • 9Grasso S, Stripoli T, Saeehi M, et al. Inhomogeneity of lung parenehyma during the open lung strategy: a computed tomography scan study[J]. Am J Respir Crit Care Med,2009, 180(5) :415-423.
  • 10Duff JP,Rosychuk RJ ,Joffe AR. The safety and efficacy of lung reeruitment maneuver in pediatric intensive care unit patients [J]. Intensive Care Med, 2007,33(10) : 1778-1786.

二级参考文献20

  • 1Falke K J,Pontoppidan H,Kumar A,et al.Ventilation with end-expiratory pressure in acute lung disease[J].J Clin Invest,1972,51:2315-2323.
  • 2International Consensus Conferences in Intensive Care Medicine.Ventilator-associated lung injury in ARDS[J].Am J Respir Crit Care Med,1999,160:2118-2124.
  • 3Artigas A,Bernard G R,Carlet J,et al.The American-European Consensus Conference on ARDS(part 2):ventilatory,pharmacologic,supportive therapy,study design strategies and issues related to recovery and remodeling[J].Intensive Care Med,1998,24:378-398.
  • 4Amato M B,Barbas C S,Medeiros D M,et al.Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome[J].N Engl J Med,1998,338:347-354.
  • 5The Acute Respiratory Distress Syndrome Network.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome[J].N Engl J Med,2000,342:1301-1308.
  • 6Webb H H,Tierney D F.Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures:protection by positive end-expiratory pressure[J].Am Rev Respir Dis,1974,110:556-565.
  • 7Pelosi P,Bottino N,Chiumello D,et al.Sigh in supine and prone position during acute respiratory distress syndrome[J].Am J Respir Care Med,2003,167:521-527.
  • 8Richard J C,Maggiore S M,Jonson B,et al.Influence of tidal volume on alveolar recruitment:respective role of PEEP and a recruitment maneuver[J].Am J Respir Crit Care Med,2001,163:1609-1613.
  • 9Lu Q,Capderou A,Cluzel P,et al.A computed tomographic scan assessment of endotracheal suctioning-induced bronchoconstriction in ventilated sheep[J].Am J Respir Crit Care Med,2000,162:1898-1904.
  • 10Papadakos P J,Lachnann B.The open lung concept of alveolar recruitment can improve outcome in respiratory failure and ARDS[J].Mt Sinai J Med,2002,69:74-76.

共引文献26

同被引文献10

引证文献2

二级引证文献1

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部