中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2013年
12期
7-9
,共3页
王存%郭发良%卜会驹%黄辉%莫伟胜%杨秀洁%林小茂
王存%郭髮良%蔔會駒%黃輝%莫偉勝%楊秀潔%林小茂
왕존%곽발량%복회구%황휘%막위성%양수길%림소무
急性呼吸窘迫综合征%肺复张%双水平正压通气%改良叹气法%压力控制法
急性呼吸窘迫綜閤徵%肺複張%雙水平正壓通氣%改良歎氣法%壓力控製法
급성호흡군박종합정%폐복장%쌍수평정압통기%개량우기법%압력공제법
Acute respiratory distress syndrome%Recruitment maneuver%Bi-level positive airway%Modified sigh%Pressure control ventilation
目的 比较两种肺复张策略用于肺外源性急性呼吸窘迫综合征(ARDS)患者的效果及其对血流动力学的影响.方法 肺外源性ARDS患者36例,按照交叉设计的方法在不同时段随机选用双水平正压通气+压力支持通气(BILEVEL+ PSV)模式改良叹气法及压力控制法,记录肺复张前后患者氧合指数(PaO2/FiO2)、肺静态顺应性(Cstat)、心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)等指标的变化,并行统计学分析.结果 两种肺复张方法患者PaO2/FiO2和Cstat在肺复张后比肺复张前均有改善,在肺复张后30、60 min两种肺复张方法效果比较差异无统计学意义,而复张后120 min BILEVEL+ PSV模式改良叹气法患者PaO2/FiO2[(210.2±29.7) mm Hg vs(162.8±27.8)mmHg,1 mm Hg=0.133 kPa]和Cstat[(43.3±12.0) vs(32.9±9.6) ml/cm H20,1 cm H2O=0.098 kPa]均较压力控制法好,差异有统计学意义(P＜0.05).两肺复张方法在复张后即刻对HR、MAP、CVP均有影响,而BILEVEL+ PSV模式改良叹气法在肺复张后10 min患者HR、MAP、CVP已基本恢复到复张前水平,压力控制法肺复张后10 min患者HR、CVP仍有升高,MAP仍较低,复张后20 min才恢复到复张前水平.结论 在肺外源性ARDS患者应用PB-840呼吸机实施BILEVEL+ PSV模式改良叹气法肺复张效果显著,改善氧合及肺顺应性较压力控制法维持时间长,并且患者耐受性好,对血流动力学影响小.
目的 比較兩種肺複張策略用于肺外源性急性呼吸窘迫綜閤徵(ARDS)患者的效果及其對血流動力學的影響.方法 肺外源性ARDS患者36例,按照交扠設計的方法在不同時段隨機選用雙水平正壓通氣+壓力支持通氣(BILEVEL+ PSV)模式改良歎氣法及壓力控製法,記錄肺複張前後患者氧閤指數(PaO2/FiO2)、肺靜態順應性(Cstat)、心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)等指標的變化,併行統計學分析.結果 兩種肺複張方法患者PaO2/FiO2和Cstat在肺複張後比肺複張前均有改善,在肺複張後30、60 min兩種肺複張方法效果比較差異無統計學意義,而複張後120 min BILEVEL+ PSV模式改良歎氣法患者PaO2/FiO2[(210.2±29.7) mm Hg vs(162.8±27.8)mmHg,1 mm Hg=0.133 kPa]和Cstat[(43.3±12.0) vs(32.9±9.6) ml/cm H20,1 cm H2O=0.098 kPa]均較壓力控製法好,差異有統計學意義(P＜0.05).兩肺複張方法在複張後即刻對HR、MAP、CVP均有影響,而BILEVEL+ PSV模式改良歎氣法在肺複張後10 min患者HR、MAP、CVP已基本恢複到複張前水平,壓力控製法肺複張後10 min患者HR、CVP仍有升高,MAP仍較低,複張後20 min纔恢複到複張前水平.結論 在肺外源性ARDS患者應用PB-840呼吸機實施BILEVEL+ PSV模式改良歎氣法肺複張效果顯著,改善氧閤及肺順應性較壓力控製法維持時間長,併且患者耐受性好,對血流動力學影響小.
목적 비교량충폐복장책략용우폐외원성급성호흡군박종합정(ARDS)환자적효과급기대혈류동역학적영향.방법 폐외원성ARDS환자36례,안조교차설계적방법재불동시단수궤선용쌍수평정압통기+압력지지통기(BILEVEL+ PSV)모식개량우기법급압력공제법,기록폐복장전후환자양합지수(PaO2/FiO2)、폐정태순응성(Cstat)、심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)등지표적변화,병행통계학분석.결과 량충폐복장방법환자PaO2/FiO2화Cstat재폐복장후비폐복장전균유개선,재폐복장후30、60 min량충폐복장방법효과비교차이무통계학의의,이복장후120 min BILEVEL+ PSV모식개량우기법환자PaO2/FiO2[(210.2±29.7) mm Hg vs(162.8±27.8)mmHg,1 mm Hg=0.133 kPa]화Cstat[(43.3±12.0) vs(32.9±9.6) ml/cm H20,1 cm H2O=0.098 kPa]균교압력공제법호,차이유통계학의의(P＜0.05).량폐복장방법재복장후즉각대HR、MAP、CVP균유영향,이BILEVEL+ PSV모식개량우기법재폐복장후10 min환자HR、MAP、CVP이기본회복도복장전수평,압력공제법폐복장후10 min환자HR、CVP잉유승고,MAP잉교저,복장후20 min재회복도복장전수평.결론 재폐외원성ARDS환자응용PB-840호흡궤실시BILEVEL+ PSV모식개량우기법폐복장효과현저,개선양합급폐순응성교압력공제법유지시간장,병차환자내수성호,대혈류동역학영향소.
Objective To compare the effect of two recruitment maneuvers (RM) in acute respiratory distress syndrome caused by extrapulmonary disease.Methods A total of 36 acute respiratory distress syndrome patients caused by extrapulmonary disease were enrolled.According to crossover design methods,they were undergone two RM in different periods,including Bi-level positive airway + pressure support ventilation (BILEVEL + PSV) modified sigh and pressure control ventilation (PCV).Oxygenation index(PaO2/FiO2),lung static compliance (Cstat),and heart rate(HR),mean arterial blood pressure(MAP),central venous pressure(CVP),were recorded before and after RM,and were analyzed for statistical analysis.Results PaO2/FiO2,Cstat were increased significantly after two RMs than before.There was no significantly different between the two methods in period of 30 min and 60 min after RM.PaO2/FiO2 and Cstat in period of 120 min after BILEVEL + PSV modified sigh were significantly higher than that of PCV [PaO2/FiO2:(210.2 ± 29.7) mm Hg vs (162.8 ± 27.8) mm Hg,Cstat:(43.3 ±12.O) ml/cm H2O vs (32.9 ± 9.6) ml/cm H2O,P ＜ 0.05].After RM,HR and CVP were increased,MAP was decreased at once,and there was no difference in two methods.HR,MAP and CVP restored to the previous levels in period of 10 min after BILEVEL + PSV modified sigh,but in period of 20 min after PCV.Conclusions BILEVEL + PSV modified sigh using PB-840 ventilator can be applied to the patients suffering from extrapulmonary acute respiratory distress syndrome,and can improve oxygenation index,lung static compliance significantly.It can maintain a longer time and better tolerance and lighter interference to hemodynamic than PCV.
