中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
7期
606-610
,共5页
控制性肺膨胀%急性呼吸窘迫综合征%吸痰%肺复张
控製性肺膨脹%急性呼吸窘迫綜閤徵%吸痰%肺複張
공제성폐팽창%급성호흡군박종합정%흡담%폐복장
Sustained inflation%Acute respiratory distress syndrome%Sputum aspiration%Lung recruitment
目的：探讨不同压力的控制性肺膨胀（SI）对急性呼吸窘迫综合征（ARDS）患者不同负压吸痰后肺复张的影响。方法前瞻性单盲随机对照研究设计，采用析因方差分析法，选择2012年1月至2014年12月重庆三峡中心医院急救重症加强治疗病房（ICU）收治的ARDS患者150例，按随机数字表法将其分为S1、S2、S3组，每组50例，分别应用150、175、200 mmHg（1 mmHg＝0.133 kPa）负压吸痰；然后每组再随机分为P0、P1、P2、P3、P4亚组，每组10例，分别采用0、30、35、40、45 cmH2O（1 cmH2O＝0.098 kPa）复张压力进行SI。记录并比较吸痰前后以及进行肺复张后患者的呼吸力学指标及血流动力学指标。结果150例患者吸痰后肺复张容积（mL：87.56±28.47比109.38±34.63，t＝3.573，P＝0.001）和肺静态顺应性〔Cst（mL/cmH2O）：27.69±13.25比35.87±17.47，t＝2.814，P＝0.004〕较吸痰前显著降低，气道峰压〔PIP（cmH2O）：24.16±8.28比18.63±6.67，t＝2.957，P＝0.005〕、气道平台压〔Pplat（cmH2O）：21.28±9.14比17.47±7.26，t＝2.089， P＝0.032〕、气道平均压〔Pm（cmH2O）：13.26±4.65比10.41±3.54，t＝3.271，P＝0.001〕较吸痰前明显升高。肺复张容积、Cst、PIP、Pplat、Pm在不同吸痰负压间差异无统计学意义（F值分别为0.809、0.986、1.121、0.910、1.043，P值分别为0.452、0.381、0.335、0.410、0.361），在不同肺复张压力间差异有统计学意义（F值分别为3.581、5.028、3.064、3.036、4.050，P值分别为0.013、0.002、0.026、0.027、0.007），且两因素不存在交互作用。两两比较后发现，在相同吸痰负压条件下，不同复张压力亚组（P1、P2、P3、P4）肺复张容积、Cst均明显高于其P0亚组，PIP、Pplat、Pm均明显低于P0亚组；而P1、P2、P3、P4亚组间差异无统计学意义。平均动脉压（MAP）、肺动脉压（PAP）在不同吸痰负压及不同肺复张压力间差异均无统计学意义（吸痰负压：F＝0.586、P＝0.561， F＝1.373、P＝0.264；肺复张压：F＝1.313、P＝0.280，F＝1.621、P＝0.186），而且两因素间不存在交互作用（F＝0.936、P＝0.497，F＝1.391、P＝0.227）；心率（HR）在不同吸痰负压间差异无统计学意义（F＝1.144，P＝0.328），在不同肺复张压间差异有统计学意义（F＝3.297，P＝0.019），且两因素间不存在交互作用（F＝1.277， P＝0.280）。两两比较发现，在相同吸痰负压条件下，P3、P4亚组HR明显高于P0、P1、P2亚组（均P＜0.05）。结论30 cmH2O和35 cmH2O为实施SI治疗ARDS患者的适合压力，且不受吸痰负压的影响。
目的：探討不同壓力的控製性肺膨脹（SI）對急性呼吸窘迫綜閤徵（ARDS）患者不同負壓吸痰後肺複張的影響。方法前瞻性單盲隨機對照研究設計，採用析因方差分析法，選擇2012年1月至2014年12月重慶三峽中心醫院急救重癥加彊治療病房（ICU）收治的ARDS患者150例，按隨機數字錶法將其分為S1、S2、S3組，每組50例，分彆應用150、175、200 mmHg（1 mmHg＝0.133 kPa）負壓吸痰；然後每組再隨機分為P0、P1、P2、P3、P4亞組，每組10例，分彆採用0、30、35、40、45 cmH2O（1 cmH2O＝0.098 kPa）複張壓力進行SI。記錄併比較吸痰前後以及進行肺複張後患者的呼吸力學指標及血流動力學指標。結果150例患者吸痰後肺複張容積（mL：87.56±28.47比109.38±34.63，t＝3.573，P＝0.001）和肺靜態順應性〔Cst（mL/cmH2O）：27.69±13.25比35.87±17.47，t＝2.814，P＝0.004〕較吸痰前顯著降低，氣道峰壓〔PIP（cmH2O）：24.16±8.28比18.63±6.67，t＝2.957，P＝0.005〕、氣道平檯壓〔Pplat（cmH2O）：21.28±9.14比17.47±7.26，t＝2.089， P＝0.032〕、氣道平均壓〔Pm（cmH2O）：13.26±4.65比10.41±3.54，t＝3.271，P＝0.001〕較吸痰前明顯升高。肺複張容積、Cst、PIP、Pplat、Pm在不同吸痰負壓間差異無統計學意義（F值分彆為0.809、0.986、1.121、0.910、1.043，P值分彆為0.452、0.381、0.335、0.410、0.361），在不同肺複張壓力間差異有統計學意義（F值分彆為3.581、5.028、3.064、3.036、4.050，P值分彆為0.013、0.002、0.026、0.027、0.007），且兩因素不存在交互作用。兩兩比較後髮現，在相同吸痰負壓條件下，不同複張壓力亞組（P1、P2、P3、P4）肺複張容積、Cst均明顯高于其P0亞組，PIP、Pplat、Pm均明顯低于P0亞組；而P1、P2、P3、P4亞組間差異無統計學意義。平均動脈壓（MAP）、肺動脈壓（PAP）在不同吸痰負壓及不同肺複張壓力間差異均無統計學意義（吸痰負壓：F＝0.586、P＝0.561， F＝1.373、P＝0.264；肺複張壓：F＝1.313、P＝0.280，F＝1.621、P＝0.186），而且兩因素間不存在交互作用（F＝0.936、P＝0.497，F＝1.391、P＝0.227）；心率（HR）在不同吸痰負壓間差異無統計學意義（F＝1.144，P＝0.328），在不同肺複張壓間差異有統計學意義（F＝3.297，P＝0.019），且兩因素間不存在交互作用（F＝1.277， P＝0.280）。兩兩比較髮現，在相同吸痰負壓條件下，P3、P4亞組HR明顯高于P0、P1、P2亞組（均P＜0.05）。結論30 cmH2O和35 cmH2O為實施SI治療ARDS患者的適閤壓力，且不受吸痰負壓的影響。
목적：탐토불동압력적공제성폐팽창（SI）대급성호흡군박종합정（ARDS）환자불동부압흡담후폐복장적영향。방법전첨성단맹수궤대조연구설계，채용석인방차분석법，선택2012년1월지2014년12월중경삼협중심의원급구중증가강치료병방（ICU）수치적ARDS환자150례，안수궤수자표법장기분위S1、S2、S3조，매조50례，분별응용150、175、200 mmHg（1 mmHg＝0.133 kPa）부압흡담；연후매조재수궤분위P0、P1、P2、P3、P4아조，매조10례，분별채용0、30、35、40、45 cmH2O（1 cmH2O＝0.098 kPa）복장압력진행SI。기록병비교흡담전후이급진행폐복장후환자적호흡역학지표급혈류동역학지표。결과150례환자흡담후폐복장용적（mL：87.56±28.47비109.38±34.63，t＝3.573，P＝0.001）화폐정태순응성〔Cst（mL/cmH2O）：27.69±13.25비35.87±17.47，t＝2.814，P＝0.004〕교흡담전현저강저，기도봉압〔PIP（cmH2O）：24.16±8.28비18.63±6.67，t＝2.957，P＝0.005〕、기도평태압〔Pplat（cmH2O）：21.28±9.14비17.47±7.26，t＝2.089， P＝0.032〕、기도평균압〔Pm（cmH2O）：13.26±4.65비10.41±3.54，t＝3.271，P＝0.001〕교흡담전명현승고。폐복장용적、Cst、PIP、Pplat、Pm재불동흡담부압간차이무통계학의의（F치분별위0.809、0.986、1.121、0.910、1.043，P치분별위0.452、0.381、0.335、0.410、0.361），재불동폐복장압력간차이유통계학의의（F치분별위3.581、5.028、3.064、3.036、4.050，P치분별위0.013、0.002、0.026、0.027、0.007），차량인소불존재교호작용。량량비교후발현，재상동흡담부압조건하，불동복장압력아조（P1、P2、P3、P4）폐복장용적、Cst균명현고우기P0아조，PIP、Pplat、Pm균명현저우P0아조；이P1、P2、P3、P4아조간차이무통계학의의。평균동맥압（MAP）、폐동맥압（PAP）재불동흡담부압급불동폐복장압력간차이균무통계학의의（흡담부압：F＝0.586、P＝0.561， F＝1.373、P＝0.264；폐복장압：F＝1.313、P＝0.280，F＝1.621、P＝0.186），이차량인소간불존재교호작용（F＝0.936、P＝0.497，F＝1.391、P＝0.227）；심솔（HR）재불동흡담부압간차이무통계학의의（F＝1.144，P＝0.328），재불동폐복장압간차이유통계학의의（F＝3.297，P＝0.019），차량인소간불존재교호작용（F＝1.277， P＝0.280）。량량비교발현，재상동흡담부압조건하，P3、P4아조HR명현고우P0、P1、P2아조（균P＜0.05）。결론30 cmH2O화35 cmH2O위실시SI치료ARDS환자적괄합압력，차불수흡담부압적영향。
ObjectiveTo investigate the effect of different degrees of pressure of sustained inflation (SI) in patients with acute respiratory distress syndrome (ARDS) after lung recruitment as the result of different negative pressure for sputum aspiration.Methods A prospective single-blind randomized controlled trial was conducted. The factorial analysis of variance was adopted. 150 patients with ARDS admitted to the emergency intensive care unit (ICU) of Chongqing Three Gorges Central Hospital from January 2012 to December 2014 were enrolled, and they were randomly divided into S1, S2, S3 group, with 50 patients in each group, suction pressure varying from 150, 175, to 200 mmHg (1 mmHg = 0.133 kPa) was respectively used in each group. Then the patients of each group were randomly subdivided into five subgroups of P0, P1, P2, P3, P4, with 10 patients in each group, and 0, 30, 35, 40, and 45 cmH2O (1 cmH2O = 0.098 kPa) were used for control pulmonary inflation pressure, respectively. The respiratory mechanics and the hemodynamic parameters were recorded, and they were compared before and after the sputum aspiration as well as lung recruitment with sustained inflation.Results The lung recruitment volume (mL: 87.56±28.47 vs. 109.38±34.63, t = 3.573,P = 0.001) and lung static compliance [Cst ( mL/cmH2O): 27.69±13.25 vs. 35.87±17.47,t = 2.814,P = 0.004] after sputum aspiration in the 150 patients were significantly lower than those before the sputum aspiration, and peak airway pressure [PIP (cmH2O): 24.16±8.28 vs. 18.63±6.67,t = 2.957,P = 0.005], airway plateau pressure [Pplat (cmH2O): 21.28±9.14 vs. 17.47±7.26,t = 2.089,P = 0.032], and mean airway pressure [Pm (cmH2O): 13.26±4.65 vs. 10.41±3.54,t = 3.271,P = 0.001] were significantly higher than those before the treatment. There were no significant differences in the lung recruitment volume, Cst, PIP, Pplat and Pm between groups with different negative pressure for sputum aspiration (F value was 0.809, 0.986, 1.121, 0.910, 1.043, andP value was 0.452, 0.381, 0.335, 0.410, 0.361), but statistical significance was found among different groups of different lung recruitment pressures (F value was 3.581, 5.028, 3.064, 3.036, 4.050, andP value was 0.013, 0.002, 0.026, 0.027, 0.007). There was no interaction between the two factors. After pairwise comparison, under the same negative pressure for sputum aspiration, lung recruitment volume and Cst in different lung recruitment pressures subgroups (P1, P2, P3, P4) were significantly higher than those of P0 subgroup, and PIP, Pplat, and Pm were significantly lower than those of P0 subgroup. There was no significant difference among P1, P2, P3 and P4 groups. There were no significant differences in mean arterial pressure (MAP) and pulmonary arterial pressure (PAP) among different groups with negative pressures for sputum aspiration and different lung recruitment pressures (negative pressure for sputum aspiration:F = 0.586,P = 0.561,F= 1.373,P = 0.264; lung recruitment pressure:F = 1.313,P = 0.280,F= 1.621,P = 0.186), there was no interaction between the two factors (F = 0.936,P = 0.497,F = 1.391,P = 0.227). The difference of heart rate (HR) in different negative pressure for sputum aspiration groups was not significant (F = 1.144,P = 0.328), and there were significant differences in different lung recruitment pressure groups (F = 3.297,P = 0.019), there was no interaction between the two factors (F = 1.277, P = 0.280). After pairwise comparison, under the same negative pressure for sputum aspiration, HR in P3 and P4 subgroups was significantly higher than that in P0, P1, and P2 subgroups (allP< 0.05).Conclusion 30 cmH2O and 35 cmH2O were the suitable pressure for SI in ARDS patients, and they were not affected by different negative pressure for sputum aspiration.
