中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
10期
604-608
,共5页
汪宗昱%朱曦%李宏亮%王铁华%么改琦
汪宗昱%硃晞%李宏亮%王鐵華%麽改琦
왕종욱%주희%리굉량%왕철화%요개기
急性呼吸窘迫综合征%肺复张%血管外肺水
急性呼吸窘迫綜閤徵%肺複張%血管外肺水
급성호흡군박종합정%폐복장%혈관외폐수
acute respiratory distress syndrome%recruitment maneuver%extravascular lung water
目的 探讨肺复张(RM)策略对急性呼吸窘迫综合征(ARDS)患者血管外肺水(EVLW)的影响.方法 采用随机对照病例研究方法,将20例ARDS患者随机分为RM组和对照组.按肺保护性通气策略的原则给患者进行机械通气;用双水平气道正压(BIPAP)通气模式进行RM,每8 h重复1次,连续7 d或至脱机前;除RM外,其余治疗两组相同.记录患者的基线资料和每日RM结束后的EVLW、血管外肺水指数(EVLWI)、呼吸力学参数、氧合指数(PaO2/FiO2)、中心静脉压(CVP)、血浆胶体渗透压(COP)以及糖皮质激素、肾上腺素能药物用量和24 h液体出入量平衡等影响EVLW各因素的数值.结果 RM组和对照组EVLW、EVLWI随时间延长呈逐渐降低趋势,但两组间比较差异无统计学意义(P均>0.05).两组间CVP、COP和去甲肾上腺素、氢化可的松用量比较差异均无统计学意义(P均>0.05);RM组多巴胺用量在4 d时明显少于对照组(P<0.05);液体出入量平衡RM组7 d时为负平衡,对照组则为正平衡(P<0.05).RM组平均气道压(Pmean)的均值[(18.8±3.2)cm H2O(1 cm H2O=0.098 kPa)]和肺准静态顺应性(Cstat)的均值[(36.5±14.5)ml/cm H2O]均明显高于对照组[(16.6±3.9)cm H2O和(29.3±12.0)ml/cm H2O,P均<0.05];其中RM组5 d时Cstat大于2 d和3 d时(P均<0.05).两组间PaO2/FiO2比较则未见明显差异(P均>0.05).结论 针对ARDS患者实施的RM治疗并没有明显影响EVLW,而仅起到了改善肺呼吸力学特征的作用.本研究中所涉及的影响肺水的因素并未影响肺水的形成和清除.
目的 探討肺複張(RM)策略對急性呼吸窘迫綜閤徵(ARDS)患者血管外肺水(EVLW)的影響.方法 採用隨機對照病例研究方法,將20例ARDS患者隨機分為RM組和對照組.按肺保護性通氣策略的原則給患者進行機械通氣;用雙水平氣道正壓(BIPAP)通氣模式進行RM,每8 h重複1次,連續7 d或至脫機前;除RM外,其餘治療兩組相同.記錄患者的基線資料和每日RM結束後的EVLW、血管外肺水指數(EVLWI)、呼吸力學參數、氧閤指數(PaO2/FiO2)、中心靜脈壓(CVP)、血漿膠體滲透壓(COP)以及糖皮質激素、腎上腺素能藥物用量和24 h液體齣入量平衡等影響EVLW各因素的數值.結果 RM組和對照組EVLW、EVLWI隨時間延長呈逐漸降低趨勢,但兩組間比較差異無統計學意義(P均>0.05).兩組間CVP、COP和去甲腎上腺素、氫化可的鬆用量比較差異均無統計學意義(P均>0.05);RM組多巴胺用量在4 d時明顯少于對照組(P<0.05);液體齣入量平衡RM組7 d時為負平衡,對照組則為正平衡(P<0.05).RM組平均氣道壓(Pmean)的均值[(18.8±3.2)cm H2O(1 cm H2O=0.098 kPa)]和肺準靜態順應性(Cstat)的均值[(36.5±14.5)ml/cm H2O]均明顯高于對照組[(16.6±3.9)cm H2O和(29.3±12.0)ml/cm H2O,P均<0.05];其中RM組5 d時Cstat大于2 d和3 d時(P均<0.05).兩組間PaO2/FiO2比較則未見明顯差異(P均>0.05).結論 針對ARDS患者實施的RM治療併沒有明顯影響EVLW,而僅起到瞭改善肺呼吸力學特徵的作用.本研究中所涉及的影響肺水的因素併未影響肺水的形成和清除.
목적 탐토폐복장(RM)책략대급성호흡군박종합정(ARDS)환자혈관외폐수(EVLW)적영향.방법 채용수궤대조병례연구방법,장20례ARDS환자수궤분위RM조화대조조.안폐보호성통기책략적원칙급환자진행궤계통기;용쌍수평기도정압(BIPAP)통기모식진행RM,매8 h중복1차,련속7 d혹지탈궤전;제RM외,기여치료량조상동.기록환자적기선자료화매일RM결속후적EVLW、혈관외폐수지수(EVLWI)、호흡역학삼수、양합지수(PaO2/FiO2)、중심정맥압(CVP)、혈장효체삼투압(COP)이급당피질격소、신상선소능약물용량화24 h액체출입량평형등영향EVLW각인소적수치.결과 RM조화대조조EVLW、EVLWI수시간연장정축점강저추세,단량조간비교차이무통계학의의(P균>0.05).량조간CVP、COP화거갑신상선소、경화가적송용량비교차이균무통계학의의(P균>0.05);RM조다파알용량재4 d시명현소우대조조(P<0.05);액체출입량평형RM조7 d시위부평형,대조조칙위정평형(P<0.05).RM조평균기도압(Pmean)적균치[(18.8±3.2)cm H2O(1 cm H2O=0.098 kPa)]화폐준정태순응성(Cstat)적균치[(36.5±14.5)ml/cm H2O]균명현고우대조조[(16.6±3.9)cm H2O화(29.3±12.0)ml/cm H2O,P균<0.05];기중RM조5 d시Cstat대우2 d화3 d시(P균<0.05).량조간PaO2/FiO2비교칙미견명현차이(P균>0.05).결론 침대ARDS환자실시적RM치료병몰유명현영향EVLW,이부기도료개선폐호흡역학특정적작용.본연구중소섭급적영향폐수적인소병미영향폐수적형성화청제.
Objective To investigate the possible effects of recruitment maneuver(RM)imposing on extravascular lung water(EVLW)in patients with acute respiratory distress syndrome CARDS).Methods Twenty patients with ARDS who were eligible for the study were randomized to two groups,one group of which received regular therapy+ RM(RM group),and to the other group only regular therapy was given (control group).Mechanical ventilation of all the patients was performed on the principles of lung protective ventilation.RM was carried out in bi-level positive airway passage(BIPAP)mode,and repeated every 8 hours per day until on the 7th day or before weaning of mechanical ventilation.The treatment was same between the two groups except RM.Baseline data and the influencing factors of EVLW were all recorded,which included everyday EVLW,extravascular lung water index(EVLWI)after RM,respiratory mechanics,oxygenation parameters,central venous pressure(CVP),plasma colloid osmotic pressure (COP),dosage of corticosteroid and adrenergic drugs,24-hour net fluid balance.Results EVLW and EVLWI in RM and control group showed a tendency of decrease with passage of time,but the difference between both groups had no statistical significance(all P>0.05).The comparisons between the influencing factors of the groups,consisting of CVP,COP,noradrenalin and hydrocortisone,had no significant difference either(all P>0.05).Dopamine dosage in RM group on the 4th day was smaller than that of control group(P<0.05).Net fluid balance in RM group on the 7th day was negative,whereas it was positive in control group(P<0.05).Mean airway pressure[Pmean,RM group(18.8 ±3.2)cm H2O (1 cm H2O=0.098 kPa)vs.control group(16.6±3.9)cm H2O]and lung quasi-static compliance[Cstat,RM group(36.5±14.5)ml/cm H2O vs.control group(29.3±12.0)ml/cm H2O]in RM group were higher than those in control group(both P<0.05).Cstat on the 5th day was higher than that on the 2nd and 3rd day in RM group(both P<0.05).But oxygenation index(PaO2/FiO2)showed no distinct difference between the groups(all P>0.05).Conclusion RM for the patients with ARDS can merely improve lung mechanics without obvious effect on EVLW.Neither of the influencing factors involved in the study has impact on emergence and clearance of EVLW.
