早期机械通气治疗对急性高原肺水肿继发急性呼吸窘迫综合征患者氧合及血流动力学的影响
조기궤계통기치료대급성고원폐수종계발급성호흡군박종합정환자양합급혈류동역학적영향
Effects of early mechanical ventilation on oxygenation and hemodynamics in acute high altitude pulmonary edema patients complicated by acute respiratory distress syndrome
  • 万方数据
    中华危重病急救医学 중화위중병급구의학
    Chinese Critical Care Medicine
    2013年 10期 618-621 ,共4页

    石钟山%马四清%陈强%何宗钊

    석종산%마사청%진강%하종쇠

    高原肺水肿%急性呼吸窘迫综合征%机械通气%血流动力学%氧动力学 高原肺水腫%急性呼吸窘迫綜閤徵%機械通氣%血流動力學%氧動力學
    고원폐수종%급성호흡군박종합정%궤계통기%혈류동역학%양동역학
    High altitude pulmonary edema%Acute respiratory distress syndrome%Mechanical ventilation%Hemodynamic%Oxygen dynamic
    目的 探讨早期机械通气治疗对急性高原肺水肿(HAPE)继发急性呼吸窘迫综合征(ARDS)患者氧合及血流动力学的影响.方法 以2001年5月至2006年12月格尔木市人民医院收治的8例HAPE继发ARDS患者为研究对象,在肺水肿发生24 h内接受有创机械通气治疗,监测治疗前及治疗96 h后血流动力学和心排血量、动脉和混合静脉血气及氧代谢指标.结果 治疗前患者右房压(RAP)、平均肺动脉压(mPAP)、肺循环阻力指数(PVRI)、肺内分流(Qs/Qt)均高于正常,氧输送(DO2)、氧摄取率(O2ER)及氧合指数(PaO2/FiO2)均低于正常.机械通气治疗后,患者动脉血氧分压(PaO2)、PaO2/FiO2、动脉血氧饱和度(SaO2)、混合静脉血氧分压(Pv-O2)、混合静脉血氧饱和度(S(v)O2)均较治疗前明显增加[PaO2(mm Hg,1 mm Hg=0.133 kPa):70.3±2.9比49.9±3.5,t=15.292,P=0.001;PaO2/FiO2(mm Hg):201.6±4.8比134.5±5.2,t=19.618,P=0.004;SaO2:0.929±0.021比0.780±0.073,t=6.226,P=0.002;Pv-O2(mm Hg):54.8±2.9比44.9±2.6,t=6.767,P=0.002;Sv-O2:0.726±0.017比0.663±0.053,t=3.262,P=0.008],心率(HR)、RAP、mPAP、肺动脉楔压(PAWP)、PVRI、右心室作功指数(RVSWI)、Qs/Qt较治疗前明显降低[HR(次/min):73±2比102±13,t=6.228,P=0.000;RAP(mm Hg):6.9±1.0比13.9±1.5,t=3.609,P=0.008;mPAP(mm Hg):18.5±2.9比41.6±3.0,t=4.773,P=0.000;PAWP(mm Hg):6.9±2.2比14.0±4.2,t=2.747,P=0.030;PVRI(kPa·s·L-1):26.3±1.7比49.6±10.0,t=9.861,P=0.000;RVSWI(g·cm-1·min·m2):11.0±1.9比22.0±1.5,t=12.704,P=0.000;Qs/Qt:(26±18)％比(35±15)％,t=7.603,P=0.000],同时心排血指数(CI)、DO2、氧消耗(VO2)、O2ER亦较治疗前明显增加[CI(mL·s-1 ·m-2):71.68±6.67比70.01±6.67,t=2.832,P=0.036;DO2(L·min-1·m-2):460.9±14.0比410.0±3.1,t=9.268,P=0.000;VO2(L·min-1·m-2):158.5±9.2比129.9±5.3,t=2.818,P=0.004;O2ER:(20±1)％比(18±1)％,t=7.652,P=0.000].经治疗8例患者全部存活.结论 HAPE继发ARDS在导致呼吸衰竭的同时出现明显肺循环血流动力学及全身氧代谢紊乱,以早期机械通气为核心的综合治疗可明显改善患者的氧合,纠正肺动脉高压,提高患者心排血量及氧输送.
    목적 탐토조기궤계통기치료대급성고원폐수종(HAPE)계발급성호흡군박종합정(ARDS)환자양합급혈류동역학적영향.방법 이2001년5월지2006년12월격이목시인민의원수치적8례HAPE계발ARDS환자위연구대상,재폐수종발생24 h내접수유창궤계통기치료,감측치료전급치료96 h후혈류동역학화심배혈량、동맥화혼합정맥혈기급양대사지표.결과 치료전환자우방압(RAP)、평균폐동맥압(mPAP)、폐순배조력지수(PVRI)、폐내분류(Qs/Qt)균고우정상,양수송(DO2)、양섭취솔(O2ER)급양합지수(PaO2/FiO2)균저우정상.궤계통기치료후,환자동맥혈양분압(PaO2)、PaO2/FiO2、동맥혈양포화도(SaO2)、혼합정맥혈양분압(Pv-O2)、혼합정맥혈양포화도(S(v)O2)균교치료전명현증가[PaO2(mm Hg,1 mm Hg=0.133 kPa):70.3±2.9비49.9±3.5,t=15.292,P=0.001;PaO2/FiO2(mm Hg):201.6±4.8비134.5±5.2,t=19.618,P=0.004;SaO2:0.929±0.021비0.780±0.073,t=6.226,P=0.002;Pv-O2(mm Hg):54.8±2.9비44.9±2.6,t=6.767,P=0.002;Sv-O2:0.726±0.017비0.663±0.053,t=3.262,P=0.008],심솔(HR)、RAP、mPAP、폐동맥설압(PAWP)、PVRI、우심실작공지수(RVSWI)、Qs/Qt교치료전명현강저[HR(차/min):73±2비102±13,t=6.228,P=0.000;RAP(mm Hg):6.9±1.0비13.9±1.5,t=3.609,P=0.008;mPAP(mm Hg):18.5±2.9비41.6±3.0,t=4.773,P=0.000;PAWP(mm Hg):6.9±2.2비14.0±4.2,t=2.747,P=0.030;PVRI(kPa·s·L-1):26.3±1.7비49.6±10.0,t=9.861,P=0.000;RVSWI(g·cm-1·min·m2):11.0±1.9비22.0±1.5,t=12.704,P=0.000;Qs/Qt:(26±18)％비(35±15)％,t=7.603,P=0.000],동시심배혈지수(CI)、DO2、양소모(VO2)、O2ER역교치료전명현증가[CI(mL·s-1 ·m-2):71.68±6.67비70.01±6.67,t=2.832,P=0.036;DO2(L·min-1·m-2):460.9±14.0비410.0±3.1,t=9.268,P=0.000;VO2(L·min-1·m-2):158.5±9.2비129.9±5.3,t=2.818,P=0.004;O2ER:(20±1)％비(18±1)％,t=7.652,P=0.000].경치료8례환자전부존활.결론 HAPE계발ARDS재도치호흡쇠갈적동시출현명현폐순배혈류동역학급전신양대사문란,이조기궤계통기위핵심적종합치료가명현개선환자적양합,규정폐동맥고압,제고환자심배혈량급양수송.
    Objective To investigate the effect of early mechanical ventilation on oxygenation and hemodynamic of acute high altitude pulmonary edema(HAPE)patients complicated by acute respiratory distress syndrome(ARDS).Methods From May 2001 to December 2006,8 HAPE patients with secondary ARDS admitted to Germud City People's Hospital were enrolled in the study.All the patients received early invasive mechanical ventilation within 24 hours of HAPE.Hemodynamics,cardiac output,arterial and mixed venous blood gas and oxygen dynamics parameters were determined before and after 96 hours of mechanical ventilation.Results Before treatment the right atrial pressure(RAP),mean pulmonary artery pressure(mPAP),pulmonary vascular resistance index(PVRI)and shunt(Qs/Qt)were above normal values.Oxygen delivery(DO2),oxygen extraction rate(O2ER),and oxygenation index (PaO2,/FiO2)were lower than normal values.After treatment with mechanical ventilation,arterial partial pressure of oxygen(PaO2),PaO2/FiO2,arterial oxygen saturation(SaO2),partial pressure of oxygen of mixed venous blood(Pv-O2)and mixed venous oxygen saturation(Sv-O2)were increased significantly compared with those before treatment[PaO2(mm Hg,1 mm Hg=0.133 kPa):70.3±2.9 vs.49.9±3.5,t=15.292,P=0.001;PaO2/FiO2(mm Hg):201.6±4.8 vs.134.5±5.2,t=19.618,P=0.004;SaO2:0.929±0.021 vs.0.780±0.073,t=6.226,P=0.002;Pv-O2(mm Hg):54.8±2.9 vs.44.9±2.6,t=6.767,P=0.002;S(v)O2:0.726±0.017 vs.0.663±0.053,t=3.262,P=0.008].Heart rate(HR),RAP,mPAP,pulmonary wedge pressure(PAWP),PVRI,right ventricular stroke work index(RVSWI)a nd Qs/Qt were decreased significantly compared with those before mechanical ventilation[HR(bpm):73 ±2 vs.102±13,t=6.228,P=0.000;RAP(mm Hg):6.9±1.0 vs.13.9±1.5,t=3.609,P=0.008;mPAP(mm Hg):18.5±2.9 vs.41.6±3.0,t=4.773,P=0.000;PAWP(mm Hg):6.9±2.2 vs.14.0±4.2,t=2.747,P=0.030;PVRI(kPa·s·L-1):26.3±1.7 vs.49.6±10.0,t=9.861,P=0.000;RVSWI(g·cm-1·min·m2):11.0±1.9 vs.22.0±1.5,t=12.704,P=0.000;Qs/Qt:(26±18)％ vs.(35±15)％,t=7.603,P=0.000],and cardiac index(CI),DO2,oxygen consumption(VO2)and O2ER were also increased[CI(mL·s-1 ·m-2):71.68±6.67 vs.70.01±6.67,t=2.832,P=0.036;DO2(L·min-1·m-2):460.9±14.0 vs.410.0±3.1,t=9.268,P=0.000;VO2(L·min-1·m-2):158.5±9.2 vs.129.9±5.3,t=2.818,P=0.004;O2ER:(20±1)％vs.(18±1)％,t=7.652,P=0.000].All of the 8 patients survived.Conclusions Pulmonary circulation hemodynamic and oxygen dynamic disorders were found in HAPE patients with secondary ARDS.Treatment with early mechanical ventilation not only improved oxygenation but also reduced pulmonary hypertension and increased cardiac output and DO2.
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