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目的:探索肺源性和非肺源性急性呼吸窘迫综合征(ARDS)早期患儿在不同呼气末正压(positive end expiratory pressure,PEEP)时氧合功能和静态肺顺应性的差异。方法:选取2012-08-2015-06我院PICU住院的ARDS患儿73例,分为肺源性ARDS组(ARDSp,35例)和非肺源性ARDS组(ARDSexp,38例),分别在PEEP水平为0、5、10、15cmH2O时记录动脉血气参数PaO_2、PaCO_2、PaO_2/FiO_2和静态肺顺应性。在肺保护性通气治疗下比较二者在肺氧合功能和静态肺顺应性之间的差异。结果:1随着PEEP的增加,2组患儿PaO_2和PaO_2/FiO_2均呈上升趋势,且ARDSexp组PaO_2和PaO_2/FiO_2均要高于ARDSp组,当PEEP=15cmH_2O时,2组比较差异有统计学意义(P<0.05);22组PaCO_2在不同PEEP水平无明显变化;3在同一PEEP水平时,ARDSp组静态肺顺应性低于ARDSexp组,随着PEEP的增加,ARDSp组静态肺顺应性呈下降趋势,ARDSexp组则呈上升趋势,二者在PEEP水平为15cmH_2O时静态肺顺应性比较,差异有统计学意义(P<0.05)。结论:机械通气可有效改善肺源性和非肺源性ARDS早期患儿氧合功能,当PEEP=15cmH_2O,非肺源性ARDS较肺源性ARDS氧合改善更明显,且能改善非肺源性ARDS静态肺顺应性。
Objective: To explore the differences between oxygenation function and static lung compliance in different types of PEEP at early stage of pulmonary acute and non-pulmonary acute respiratory distress syndrome (ARDS). Methods: Seventy-three patients with ARDS hospitalized in PICU from 2012-08-2015-06 were divided into two groups: ARDSp (35 cases) and ARDSexp (38 cases) Arterial blood gas parameters PaO 2, PaCO 2, PaO 2 / FiO 2 and static lung compliance were recorded at PEEP levels of 0, 5, 10 and 15 cmH2O. Differences in pulmonary oxygenation and static lung compliance were compared between patients undergoing pulmonary protective ventilation. With the increase of PEEP, the PaO_2 and PaO_2 / FiO_2 in both groups showed an upward trend, and the PaO_2 and PaO_2 / FiO_2 in ARDSexp group were higher than those in ARDSp group. When PEEP = 15cmH_2O, there were statistically significant differences between the two groups (P <0.05). There was no significant change in the PaCO 2 level between the two groups at different PEEP levels. 3 At the same level of PEEP, the static lung compliance of the ARDSp group was lower than that of the ARDSexp group. With the increase of PEEP, the static lung compliance of the ARDSp group was (P <0.05). However, there was a significant difference between the two groups in ARDSexp group (P <0.05). Conclusion: Mechanical ventilation can effectively improve the oxygenation function in early stage of ARDS with pulmonary and non-pulmonary ARDS. When PEEP = 15cmH2O, non-pulmonary ARDS is more obvious than pulmonary ARDS, Sexual ARDS Static Lung Compliance.