·论著·

    外科重症加强治疗病房252 例次机械通气患者肺复张术分析

    杨自建 张翔宇 樊海蓉 蒋欣 王启星 沈菊芳 陈亮

    【摘要】 目的 总结肺复张术对机械通气患者血压、血氧饱和度(SO 2)的影响及其临床效果。方法 选

    择2005 年7 月—2007 年2 月46 例实施肺复张术患者的临床资料, 分析其复张效果、肺复张术的不良反应等。

    肺复张采取固定驱动压、逐渐升高呼气末正压(PEEP)的方法, 所有肺复张患者均进行有创动脉血压监测。结

    果 46 例患者进行了 252 次肺复张术, 其中 1 例军团菌肺炎患者发生纵隔气肿; 1 例患者因存在卵圆孔未闭,复张无效; 肺复张总有效率为91%。肺复张中有效PEEP 变化较大, 最低8 cm H2O (1 cm H2O = 01098 kPa) ,最高 30 cm H2O; SO 2 维持最短014 h, 最长368 h, 平均每例患者接受5148 次, 其中有1 例患者最多接受16 次

    肺复张术。23 例患者在肺复张中曾经发生过低氧血症(占 50% ) , 252 次肺复张术中发生 101 次低氧血症(占

    40% ) ; 开始诱发低氧血症的最低PEEP 为 8 cm H2O , 最高为 22 cm H2O , 平均 1217 cm H2O。25 例患者肺复

    张中曾发生过血压短暂降低(占 54% ) , 252 次肺复张中有 93 次血压短暂降低(占 37% ) ; 开始出现血压下降

    的最低PEEP 为6 cm H2O , 最高为23 cm H2O , 平均1319 cm H2O。结论 肺复张术可以有效改善SO 2, PEEP

    的设定应遵循个体化的原则。

    【关键词】 肺复张术; 低氧血症; 机械通气; 呼气末正压

    The analys is of 252 episodes of recruitmen tmaneuver dur ingmechan ical ven t ilat ion in surgery in ten s ive care

    un it YA N G Z i2j ian, ZH A N G X iang 2 y u, FA N H ai2rong , J IA N G X in, W A N G Q i2 x ing , SH EN

    J u2 f ang , CH EN L iang. S u rg ery Intensive Care U nit, S hang hai T enth P eop le′ s H osp ital, T ongj i

    U niversity , S hang hai 200072, Ch ina

    Corresp ond ing au thor: ZH A N G X iang 2 y u (Em ail: x iangy u62@126 . com )

    【Abstract】 Object ive To analyze the clinical effects of recruitmentmaneuver and the impacts on blood

    p ressure and oxygen saturat ion in pat ientsw ith mechanical vent ilat ion . Methods To analyze all related data

    f rom 252 ep isodes of recruitmentmaneuver of 46 pat ients adm it ted f rom July 2005 to February 2007. Recruit2

    ment maneuver method: the dr ive p ressure constantw as kep t at 15 cm H2O (1 cm H2O = 01098 kPa) and the

    po sit ive end- exp irato ry p ressure (PEEP) level w as increased gradually . Results O f the 252 ep isodes of

    recruitment maneuver, th is p rocedurew as effect ive in 91% of the pat ients, w ith pneumo tho rax and pneumo2

    mediast inum occur red in a pat ient w ith legionnaire pneumonia, and no imp rovement of oxygen saturat ion in

    one pat ient w ith patent fo ramen ovale . The value of effect ive PEEP used ranged f rom a m inimum of

    8 cm H2O to a maximum of 30 cm H2O and the durat ion of sat isfacto ry oxygen saturat ion ranged f rom a

    m inimum of 014 hour to a maximum of 368 hours . A veragely, each pat ient received 5148 ep isodes of

    recruitment maneuver w ith one of the pat ients received 16 ep isodes of recruitmentmaneuver . Tw enty- th ree

    out of the 46 pat ients (50% ) had exper ienced an ep isode of hypoxem ia . O ne hundred and one ep isodes of

    hypoxem ia occur red in 252 recruitment maneuver (40% ) and the m inimum PEEP inducing hypoxem ia is

    8 cm H2O , and the maximum PEEP w as 22 cm H2O , w ith an average value of 1217 cm H2O. Tw enty- f ive

    of the 46 pat ients ( 54% ) had exper ienced t ransient hypo tension w ith 93 ep isodes of hypoxem ia in 252

    ep isodes of recruitment maneuver (37% ) , and the m inimum PEEP inducing hypo tension w as 6 cm H2O and

    the maximum PEEP w as 23 cm H2O , w ith an average value of 1319 cm H2O. Conclus ion Recruitment

    maneuver could effect ively imp rove oxygenat ion w h ile the value of PEEP used should be individualized

    acco rding to clinical condit ion .

    【Key words】 recruitment maneuver; hypoxem ia; mechanical vent ilat ion; po sit ive end- exp irato ry

    p ressure

    作者单位: 200072 同济大学附属上海市第十人民医院S ICU

    通讯作者: 张翔宇(Email : xiangyu62@126. com)

    作者简介: 杨自建(1967- ) , 男(汉族) , 安徽省人, 医学硕士, 主

    治医师, 主要从事保护性肺通气策略研究(Em ial : yangzijiansh@

    126. com) ......