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目的评价反复肺复张联合肺保护性通气对急性呼吸窘迫综合征(ARDS)患者肺损伤的作用。方法选择30例ARDS机械通气的患者,采用双水平正压通气模式(BIPAP)实施肺复张(RM),高水平和低水平压力分别为40和20cmH2O,呼吸14次/min,吸:呼=1:1.5,时间持续2min;每2h复张1次,共复张3次(RM1、RM2、RM3)。监测肺复张前、每次肺复张后10min和反复复张后4h的血流动力学和肺气体交换及血管外肺水(EVLW)的指标;肺复张前、反复肺复张后10min和4h采集血清,采用酶联免疫吸附法(ELISA)测定TNF-α、IL-6和IL-10浓度。结果每次肺复张后10min和反复肺复张后4h与肺复张前比较,心率、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)变化没有统计学意义(P>0.05);而每次肺复张后10min和反复肺复张后4h与肺复张前比较,PaO2/FiO2明显增加,血管外肺水指数(EVLWI)明显减少,变化有统计学意义(P<0.05);RM3后10min与RM1后10min比较,PaO2/FiO2明显增加,变化有统计学差异(P<0.05);RM3后10min和反复肺复张后4h与RM1后10min比较,EVLWI减少有统计学意义(P<0.05)。反复肺复张后10min和4h与肺复张前比较,细胞因子TNF-α、IL-6、IL-10均有降低,但无统计学意义(P>0.05)。结论反复肺复张联合肺保护性通气可提高ARDS患者PaO2/FiO2,减少EVLW,且不加重ARDS的肺损伤。
Objective To evaluate the effect of recurrent lung recruitment combined with pulmonary protective ventilation on lung injury in patients with acute respiratory distress syndrome (ARDS). Methods Thirty patients with ARDS mechanical ventilation were enrolled in this study. Pulmonary reclaim (RM) was performed with bipolar positive pressure ventilation (BIPAP) at high and low levels of 40 and 20 cmH2O, respectively, with 14 breaths / min. 1: 1.5, the duration of 2min; every 2h Zhang 1, a total of 3 times a total of Zhang (RM1, RM2, RM3). Before the lung recruitment, the hemodynamics, pulmonary gas exchange and extravascular lung water (EVLW) index were measured at 10 minutes after each lung recruitment and at 4 hours after repeated exposure. Before lung recruitment, 10 minutes after repeated lung recruitment And serum samples were collected for 4h. The concentrations of TNF-α, IL-6 and IL-10 were determined by enzyme linked immunosorbent assay (ELISA). Results There were no significant differences in heart rate, mean arterial pressure (MAP), central venous pressure (CVP) and cardiac index (CI) between 10 min after each lung recruitment and 4 h after recurrent lung recruitment (P > 0.05). PaO2 / FiO2 increased significantly and the extravascular lung water index (EVLWI) decreased significantly at 10 min after reperfusion and at 4 h after repeated reexpansion <0.05). PaO2 / FiO2 increased significantly at 10 min after RM3 compared with 10 min after RM1 (P <0.05). Compared with 10 min after RM3 and 4 min after recurrent lung recovers, the decrease of EVLWI was statistically significant Significance (P <0.05). The levels of cytokines TNF-α, IL-6 and IL-10 decreased at 10 and 4 h after repeated pulmonary reuptake, but not statistically significant (P> 0.05). Conclusions Repeated pulmonary recanalization combined with pulmonary protective ventilation can increase PaO2 / FiO2, reduce EVLW, and do not aggravate ARDS in lung injury.