摘要
目的:观察不同跨肺压(Pt P)指导下机械通气(MV)对急性呼及窘迫综合征(ARDS)患者呼吸功能及血液动力学的影响。方法:采用前瞻性随机对照研究,选取ARDS患者72例,按照随机数字表法分为观察组(55例)和对照组(17例)。根据设置不同的呼气末正压(PEEP)与胸腔内压(食管球囊测定法测得)计算得出不同的Pt P,观察组中,设定Pt P分别为10、15、20 cm H_2O 3个亚组,执行MV策略;对照组根据ARDS协作网(ARDSNet)意见制定MV策略;观察2组患者机械通气后1、24、48 h呼吸力学指标及血气分析结果,采用脉搏指示连续心排血量监测仪(PICCO)监测各时间点血液动力学指标,记录患者MV时间、RICU住院时间及28 d病死率。结果:治疗后,2组患者呼吸功能及血气分析指标均好转,但对照组各时间点呼吸功能与血液动力学指标比较差异无统计学意义(P> 0. 05);通气48h后,观察组中Pt P20 cm H_2O亚组肺容积、肺静态Cst、气道PIP、气道Pplat、PEEP及PaO_2、PaCO_2、PaO_2/FiO_2均明显高于对照组(均P <0. 05);血液动力学指标MAP、CVP、CI明显低于对照组(均P <0. 05); Pt P10 cm H_2O亚组肺容积、肺静态顺应性(Cst)、气道峰压(PIP)、气道平台压(Pplat)、呼气末正压(PEEP)及PaO_2、PaCO_2、PaO_2/FiO_2均明显高于对照组(均P <0. 05);血液动力学指标与对照组比较差异不明显(P>0. 05)。Pt P20 cm H_2O亚组MV时间与RICU住院时间较对照组明显缩短(均P <0. 05);各组间28d病死率比较,差异无统计学意义(P> 0. 05)。结论:跨肺压为10 cm H_2O时的机械通气,对ARDS患者呼吸功能及通气效果较好,对血液动力学影响小,是安全可靠的保护性肺通气策略。
Objective： To observe the effect of mechanical ventilation（ MV） under the guidance of different transpulmonary pressure（ Pt P） on respiratory function and hemodynamics of acute respiratory distress syndrome（ ARDS） patients.Methods： A prospectively randomized controlled study was conducted on 72 patients with ARDS. According to the random number table method,the patients were randomly divided into observation group（ n = 55） and control group（ n = 17）. Different Pt P was calculated according to different set of positive end-expiratory pressure（ PEEP） and intrathoracic pressure（ measured by esophageal balloon assay）. In the observation group,Pt P was set as 10,15 and 20 cm H2O,respectively,and MV strategy was executed. The control group developed the MV strategy according to the comments of ARDS cooperative network（ ARDSNet）. Respiratory mechanical indexes and blood gas analysis results at 1,24,and 48 h after MV were observed,and blood flow mechanical indexes at each time point were monitored using pulse indicator continuous cardiac output monitor（ PICCO）,and MV time,RICU hospitalization time and 28-day mortality were recorded. Results： After treatment,the respiratory function and blood gas analysis indexes in the two groups were improved,but there was no statistically significant difference in respiratory function and hemodynamic indexes at each time point in the control group（ P〉0. 05）. After 48 h of ventilation,the lung volume,lung static compliance（ Cst）,airway peak pressure（ PIP）,airway platform pressure（ Pplat）,positive end-expiratory pressure（ PEEP）,PaO2,PaCO2 and PaO2/FiO2 in the Pt P20 cm H2O subgroup in the observation group were significantly higher（ all P〈0. 05）,and MAP,CVP and CI were significantly lower than those in the control group（ all P〈0. 05）. In the Pt P10 cm H2O subgroup,lung volume,Cst,PIP,Pplat,PEEP and PaO2,PaCO2 and PaO2/FiO2 were all significantly higher than those in the control group（ all P〈0. 05）. There was no significant difference in the hemodynamic indexes between two groups（ P〉0. 05）. The MV time and RICU hospitalization time in Pt P20 cm H2O subgroup were significantly shorter than those in the control group（ P〈0. 05）. There was no statistically significant difference in 28-day mortality between the two groups（ P〉0. 05）. Conclusion： When transpulmonary pressure is 10 cm H2O,MV has good respiratory function and ventilation effect for ARDS patients,has little impact on hemodynamics,and is a safe and reliable protective lung ventilation strategy.
作者
王应琼
石慧芳
何海武
王秋婷
陈兴峰
陈亚红
王茂泽
WANG Ying-qiong;SHI Hui-fang;HE Hai-wu;WANG Qiu-ting;CHEN Xing-feng;CHEN Ya-hong;WANG Mao-ze(Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China)
出处
《内科急危重症杂志》
2018年第5期359-363,共5页
Journal of Critical Care In Internal Medicine
基金
海南省自然科学基金(No:2012-812172)
关键词
跨肺压
机械通气
急性呼吸窘迫综合征
呼吸功能
血液动力学
Transpulmonary pressure
Mechanical ventilation
Acute respiratory distress syndrome
Respiratory func-tion
Hemodynamics
作者简介
通信作者：石慧芳，E-mail：ouyshan88@163．com
