实用临床医药杂志2013，Vol.17Issue(13)：20-23,4.DOI:10.7619/jcmp.201313007
肺复张策略抢救急性呼吸窘迫综合征患者的最佳PEEP设置
Study on the best PEEP settings of lung recruitment maneuver (RM) strategy in treatment of acute respiratory distress syndrome (ARDS) patients
摘要
Abstract
Objective To study the best PEEP settings of lung recruitment maneuver (RM) strategy in treatment of acute respiratory distress syndrome (ARDS) patients.Methods Thirtyseven ARDS patients after RM by using pressure control method were randomly divided into treatment group (n =19) and control group (n =18).For the treatment group,the inflection point on P-V curve deflation limb was taken as the best PEEP value.In the control group,the lower inflection point pressure (Plip) + 2 cmH2O in inflation limb on P-V curve was taken as the best PEEP value.The effects of PEEP on oxygenation and compliance of the respiratory system,hemodynamics indexes were monitored before RM and after RM (at 15 min,1 h and 2 h) in the two groups.Results PaO2 / FiO2 in the two groups of patients was significantly increased after RM (at 1 5 min,1 h,2 h)(P＜0.01),PaO2/FiO2 was higher in the treatment group after RM (at 1 h,2 h) than in the control group(P＜ 0.05,P ＜ 0.01).Cdyn in the two groups of patients was significantly increased shortly after RM (at 15 min)(P＜ 0.01).The Cdyn was higher in the treatment group after RM (at 15 min,1 h,2 h)than in the control group (P＜0.05).The mean airway pressure and peak airway pressure in the two groups were significantly increased after RM (P ＜ 0.01).The treatmentgroup and the control group were not significantly different after RM (P ＞ 0.0 5).The PaCO2 in the two groups were not significantly different after RM (P ＞0.05).In both groups,HR and CVP increased,and MAP decreased shortly after RM (at 15 min) (P＜0.01).Conclusion Lung RM strategy in treatment of ARDS patients improves oxygenation and compliance of the respiratory system.After RM,determining the PEEP for ARDS with the inflection point on P-V curve deflation limb is the best.关键词
急性呼吸窘迫综合征/肺复张策略/呼气末正压/吸气支/呼气支/P-V曲线/动态肺顺应性Key words
acute respiratory distress syndrome (ARDS)/ lung recruitment maneuver (RAM) strategy/ PEEP/ inflation limb/ deflation limb/ pressure-volume curve/ dynamic lung compliance (Cdyn)分类
医药卫生引用本文复制引用
陈文智,赵中,黄影兰,蓝志新,幸日坤,唐光大,董文韬..肺复张策略抢救急性呼吸窘迫综合征患者的最佳PEEP设置[J].实用临床医药杂志,2013,17(13):20-23,4.基金项目
云浮市医学科学科研基金项目(编号2007B022) （编号2007B022）
