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目的 :探讨利用压力 容积曲线选择呼气末正压 (PEEP)对急性呼吸窘迫综合征 (ARDS)患者肺力学、血流动力学及动脉血气参数的影响 ,并选择最佳PEEP范围。方法 :选择 16例确诊为ARDS患者 ,根据压力 容积曲线 ,设下拐点压力为PLIP,设上拐点压力为PUIP。分别选择PEEP为 0、PLIP/ 2、PLIP、(PLIP+PUIP) / 2和PUIP,测量肺力学、血流动力学及动脉血气参数的变化。结果 :当PEEP为PLIP/ 2时 ,动脉血氧分压与吸入氧浓度比 (PaO2 /FiO2 )及Cst虽然较未加用PEEP时有改善 (P <0 .0 5及P <0 .0 1) ,但尚未达到正常水平 ;当PEEP为PLIP时 ,PaO2 /FiO2 及Cst较PLIP/ 2时有显著提高 (P <0 .0 1) ,接近正常范围 ;当PEEP为PUIP时 ,PaO2 /FiO2 较(PLIP+PUIP) / 2时显著增高 (P <0 .0 1) ,但Cst较PLIP时反而有所降低 (P <0 .0 1) ,MAP下降 (P <0 .0 1) ,CVP升高 (P <0 .0 1) ,同时Pip增高 (P <0 .0 1)。结论 :ARDS患者行呼吸机治疗时 ,在PLIP～PUIP之间可有效纠正低氧血症 ,而对血流动力学影响较小 ,可获得满意疗效。
Objective: To investigate the effect of PEEP on the pulmonary mechanics, hemodynamics and arterial blood gas parameters in patients with acute respiratory distress syndrome (ARDS) and to choose the best PEEP range. Methods: Sixteen patients diagnosed as ARDS were selected. According to the pressure volume curve, the inflection point pressure was set as PLIP, and the inflection point pressure as PUIP. The changes of pulmonary mechanics, hemodynamics and arterial blood gas parameters were measured by selecting PEEP as 0, PLIP / 2, PLIP, (PLIP + PUIP) / 2 and PUIP respectively. Results: When PEEP was PLIP / 2, PaO2 / FiO2 and Cst were improved compared with those without PEEP (P <0.05 and P <0.01) ), But not yet reached the normal level. When PEEP was PLIP, PaO2 / FiO2 and Cst were significantly higher than PLIP / 2 (P <0.01), close to the normal range. When PEEP was PUIP, PaO2 / FiO2 (PLIP + PUIP) / 2 (P <0.01), but Cst was lower than PLIP (P <0.01), MAP was decreased (P < High (P <0. 01), while Pip increased (P <0. 01). CONCLUSION: ARDS patients can effectively correct hypoxemia between PLIP and PUIP while having less influence on hemodynamics when receiving ventilator treatment, and satisfactory therapeutic effect can be obtained.