摘要
目的探讨吸痰后进行高呼气末正压(PEEP)肺复张对严重脓毒症致呼吸衰竭患者的血流动力学和呼吸力学指标的影响。方法前瞻性选择2010年1月—2012年6月中国医科大学附属第一医院急诊科重症监护室(EICU)行机械通气的基础疾病为严重脓毒症且并发Ⅰ型呼吸衰竭的患者118例,按照随机数字表法分为A、B两组,采用自身交叉对照的方法,A组(n=56)首先采用压力控制通气(PCV)模式然后用容量控制通气(VCV)模式,B组(n=62)则与之相反,均行开放式吸痰,每次吸痰结束后立即采取增加PEEP至20 cm H2O(1 cmH2O=0.098 kPa)持续40 s的方法进行肺复张。比较PCV模式和VCV模式下不同时间点呼吸力学和血流动力学指标的变化。结果在PCV和VCV模式下,肺复张前及肺复张后1、3 min时,患者心率均较基础水平加快、平均动脉压(MAP)降低(P<0.05),肺复张后5、10、30 min时均恢复至基础水平(P>0.05)。在PCV模式下,肺复张后1、30 min时潮气量较肺复张前分别增加43.8%、35.9%,总动态顺应性(Crs)较肺复张前分别增加42.0%、34.3%(P<0.05)。在VCV模式下,肺复张后1、30 min时气道峰压较肺复张前分别降低24.3%、22.0%,气道平台压较肺复张前分别降低25.1%、24.4%,Crs较肺复张前分别增加33.5%、37.7%(P<0.05)。结论对行机械通气的严重脓毒症患者吸痰后采取高PEEP法肺复张可引起心率和MAP的短暂变化,在PCV和VCV模式下均能够改善患者呼吸系统的Crs。
Objective To evaluate the effects of lung recruitment maneuver（RM） with high-level positive end-expiratory pressure（PEEP） after suction on hemodynamics and respiratory mechanics in patients with severe sepsis（SS）.Methods A total of 118 SS patients combined with type I respiratory failure（RF） undergoing mechanical ventilation in this hospital from January 2010 to June 2012 were divided randomly into groups A（n = 56）,B（n = 62）.By self-crossover control trials,group A first underwent constant pressure controlled ventilation（PCV） mode and then volume control ventilation（VCV） mode,group B were on the contrary to group A.Both groups were given open suction,and after every suction PEEP was instantly increased to 20 cm H2O,continuously 40 s to undergo RM.The changes of breathing mechanical and hemodynamics indicators in modes of PCV and VCV were compared at different time points.Results In modes of PCV and VCV,heart rate（HR） was faster,mean arterial pressure（MAP） lower than basal levels before RM and at min 1,3 after RM（P〈0.05）,and returned to basal levels at min 5,10,30 after RM（P〈0.05）.In PCV mode,tidal volume（TV） at min 1,30 after RM increased by 43.8%,35.9% as compared with that before RM,total dynamic compliance（Crs） by 42.0%,34.3%（P〈0.05）.In VCV mode,peak airway pressure at min 1,30 reduced by 24.3%,22.0% as compared with that before RM,plat airway pressure by 25.1%,24.4%,Crsincreased by 33.5%,37.7%（P〈0.05）.Conclusion PEEP RM can lead to temporary changes in HR and MAP in SS patients with mechanical ventilation after suction,which can improve Crsof respiratory system in both modes of PCV and VCV.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第14期1613-1616,1624,共5页
Chinese General Practice
关键词
通气机
机械
呼吸功能不全
脓毒症
肺复张
呼吸力学
Ventilator
mechanical
Respiratory insufficiency
Sepsis
Lung recruitment maneuver
Respiratory mechanics
