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目的观察呼气未正压(PEEP)递增法肺复张联合保护性通气对急性呼吸窘迫综合征(ARDS)肺换气功能及血流动学的影响。方法对35例ARDS患者行PEEP递增法肺复张;测定肺复张前及肺复张后10mim、30min、1h、4h、24h时患者的氧合、呼吸力学和循环指标变化。结果肺复张后的脉搏血氧饱和度(SpO2)、动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)呈进行性升高,气道平台压(Pplat)呈进行性降低,与肺复张前比较,差异有统计学意义(P<0.01或P<0.05)。实施肺复张前后二氧化碳分压(PaCO2)、PH值、气道峰压(PIP)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)均无明显变化,差异无统计学意义(P>0.05)。结论 PEEP递增法肺复张结合肺保护通气策略是治疗ARDS的安全有效措施。
Objective To observe the effects of pulmonary reexpansion combined with protective ventilation on pulmonary ventilation and hemodynamics in patients with acute respiratory distress syndrome (ARDS). Methods Twenty-five ARDS patients underwent PEEP incremental lung recruitment. The changes of oxygenation, respiration mechanics and circulatory indexes were measured before and after pulmonary re-extension at 10mim, 30min, 1h, 4h, 24h. Results Pulmonary oxygen saturation (SpO2), arterial oxygen saturation (SaO2), PaO2 and PaO2 / FiO2 increased significantly after airway reclaim. Pressure (Pplat) showed a progressive decrease, compared with that before lung recruitment, the difference was statistically significant (P <0.01 or P <0.05). There were no significant differences in PaCO2, PH, PIP, HR, MAP and CVP between before and after pulmonary reexpansion Significance (P> 0.05). Conclusions PEEP incremental pulmonary reexpansion combined with pulmonary protection ventilation strategy is a safe and effective treatment of ARDS.