· 论著·

    肺复张通气策略在急性呼吸窘迫综合征治疗中的临床应用

    向志 张贻秋 唐建新 贺兼斌 易高众 谢茂峰

    (湖南省怀化市第一人民医院呼吸内科 ,湖南 怀化 418000)

    [摘要] 【目的】 探讨肺复张通气策略治疗急性呼吸窘迫综合征(ARDS)的疗效和风险。 【方法】 随机将

    ARDS患者分成对照组和治疗组 ,对照组在常规治疗的基础上 ,应用 PB760 呼吸机采用小潮气量和最佳呼吸

    末正压( PEEP)的肺保护性通气策略进行机械通气 ,治疗组在对照组的机械通气治疗基础上再应用肺复张策

    略。记录肺复张前及肺复张后 12 h、 24 h、 72 h 的氧合指数( PaO2 / FiO2 ) 、 动脉二氧化碳分压( PaCO2 )以及是

    否出现气压伤等并进行对比分析。 【结果】 治疗组与对照组比较在肺复张后 12 h、 24 h、 72 h 的氧合指数

    ( PaO2 / FiO2 )均明显改善( P < 0. 05) 、 PaCO2均明显降低( P < 0. 01) ,两组气压伤发生率差异无显著性( P >

    0. 05) 。 【结论】 采用小潮气量和最佳 PEEP联合肺复张策略治疗 ARDS是安全有效的。

    [关键词] 呼吸窘迫综合征/治疗; 急性病; 肺不张

    Cl inical Appl ication of Lung Recruitment Maneuvers in the Treatment of Acute Respiratory Dis2

    tress Syndrome XIA N G Zhi , ZHA N G Yi2Qi u , TA N G J ian2x in , et al ( Department of

    Res pi ratory Medicine , the Fi rst People ’s Hos pi tal of Huai hua Ci t y , Hunan 418000 , China )

    [ Abstract] 【Objective】 To investigate the effect and risk of lung recruitment maneuvers (RM) in t reating a2

    cute respiratory dist ress syndrome (ARDS) .【Methods】ARDS patient s were randomly divided into the cont rol

    group and the t reatment group. In addition to conventional t reatment , the cont rol group received mechanical

    ventilation by using lung protective ventilation st rategy of applying small tidal volume via PB760 respiratory

    machine and optimal positive end2expiratory pressure (PEEP) . In addition to the same t reatment as the cont rol

    group , the t reatment group further received RM. Oxygen indexes ( PaO2 / FiO2 ) before applying RM and at

    12h , 24h , 72h af ter applying RM were measured. The rate of carbon dioxide elimination ( PaCO2 ) in arterial

    blood and the appearance of ventilator2associated lung injury were compared and analyzed.【Result s】 In com2

    parison to the cont rol group , the t reatment group significantly improved in oxygen indexes ( PaO2 / FiO2 ) at

    12h , 24h , and 72h af ter applying RM ( P < 0. 05) , and the level of PaO2 also significantly lowered ( P <

    0. 05) . No significant difference was found between the two groups in the occurrence rate of ventilator2associ2

    ated lung injury.【Conclusion】 The employment of small tidal volume and optimal PEEP in conjunction with

    lung recruitment maneuvers (RM) to t reat ARDS is both safe and effective.

    [ K ey words] respiratory dist ress syndrome/ TH ; acute disease ; atelectasis

    [中图分类号] R563. 8 [文献标识码] A [文章编号] 167127171 (2008) 1222208203

    [ 3 ] Crane SD , Elliot t MW, Gilligan P , et al . Randomized con2

    t rolled comparison of continuous ventilation , and standard

    t reatment in emergency positive airway pressure , bilevel non2

    invasive pulmonary edema department patient s wit h acute car2

    diogenic pulmonary edema [ J ] . Emerg Med , 2004 , 21 ( 16) :

    1552159.

    [4 ] Park M. Randomized , prospective t rial of oxygen , Continuous

    positive airway pressure , and bilevel positive airway pressure

    by face mask in acute cardiogenic pulmonary edema [ J ] . Cri t

    Care Med , 2004 ,32 (8) :4072413.

    [ 5 ] Gali B , Goyal DG. Positive pressure mechanical ventilation

    [J ] . Emerg Med Cl inical N orth A m , 2003 , 21 (2) :4532473.

    [ 6 ] Agarwal R , Aggarwal AN , Gupta D , et al . Noninvasive ven2

    tilation in acute cardiogenic pulmonary edema [ J ] . Post grad

    Med , 2005 ,81 (9) :6372642.

    [ 7 ] Erwan I. Noninvasive Mechanical ventilation in acute cardio2

    genic pulmonary edema[J ] . Cri t Care Med , 2003 , 9 (6) :67.

    [ 8 ] 毛宝龄,钱桂生. 呼吸衰竭[M] . 上海:上海科学技术出版社,2005. 153.

    [ 9 ] 罗洪波,林立,王琳.机械通气抢救急性左心衰竭的临床疗效观

    察[J ] .内科急危重症杂志,2006 ,12 (2) :64266.

    (本文编辑:丁达) [收稿日期] 2008207222

    · 8022 · 医学临床研究 2008 年12 月 第25 卷 第12 期 J Clin Res , Dec. 2008 , Vol 25 , №12 难以纠正的低氧血症是急性呼吸窘迫综合征

    (ARDS)最重要的表现之一 ,也是继发多脏器功能

    衰竭的重要原因 ,而机械通气是治疗 ARDS低氧血

    症的主要措施 ......