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 双水平正压通气对急性肺损伤患者血气及血流动力学指标的影响()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2009年第16卷第6期
页码:
454-458
栏目:
临床研究论著
出版日期:
2009-12-25

文章信息/Info

Title:
 The Effect of Bilevel Ventilation Mode on Blood Gas and Hemodynamics of Patients with Acute Lung Injury
文章编号:
1007-4848（2009）06-0454-05
作者:
 罗滨 张卫星 扶志敏 等
 1.暨南大学第二临床医学院 深圳市人民医院 心脏外科， 广东深圳 518020；2.北京大学附属深圳医院 心脏外科， 广东深圳 518020
Author(s):
 LUO Bin ; ZHANG Wei-xing ;  FU Zhi-min ;  et al .
 1.Department of Cardiac Surgery, Shenzhen People’s Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong, P.R.China; 2.Department of Cardiac Surgery, Peking University Shenzhen Hospital， Shenzhen 518020，Guangdong, P.R.China
关键词:
 ; 双水平正压通气;  急性肺损伤;  容量控制通气
Keywords:
 ; Bilevel ventilation;  Acute lung injury;  Volume control ventilation
分类号:
R655.3
DOI:
-
文献标识码:
A
摘要:
 目的 探讨应用脉搏指数连续心排血量(PiCCO)容量监测仪技术研究双水平正压通气模式对急性肺损伤(ALI)患者血气及血流动力学的影响，探讨这种新型呼吸模式应用于ALI患者的临床疗效，对循环系统的影响程度，以提高ALI的治愈率。 方法 42例ALI患者，男27例，女15例；年龄15～75岁。按患者的入院先后顺序将40例患者(2例未完成研究)分为两组，每组20例。双水平正压通气组：入院的第1～20例患者，给予双水平正压通气呼吸支持,采用支持/时间(S/T)模式，吸气末压初始设为8~10 cm H2O，逐渐增加至14~20 cm H2O，以患者舒适为宜；呼气末压初设为3~5 cm H2O，逐渐增加至8~12 cm H2O，吸入氧浓度(FiO2)保持不变。对照组：入院的第21～40例患者，采用辅助/控制(A/C)通气模式，并依次按5 cm H2O，10 cm H2O，15 cm H2O，20 cm H2O 增加呼气末正压（PEEP），每种压力持续30 min，通气支持过程中FiO2保持不变。观察两组患者的心排血量（CO）、体循环血管阻力（SVR）等血流动力学和血气指标改变。 结果 两组死亡13例，其中双水平正压通气组死亡5例,对照组死亡8例。死于多器官功能衰竭 7例，感染性休克3例，循环衰竭3例。双水平正压通气组气管内插管时间（2.9±0.8 d vs. 4.2±0.9 d, t=7.737,P=0.006）和住院时间(17.2±4.5 d vs. 18.5±3.6 d, t= 2.558,P=0.039)明显短于对照组。对照组：当PEEP在5～15 cm H2O范围内,患者动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)随着PEEP的增高而逐渐增加(P<0.05)；当PEEP增加至20 cm H2O时CO降低,SVR、肺循环阻力(PVR)和气道峰值压(PIP)较5～15 cm H2O范围时增加(P<0.05)。双水平正压通气组：PaO2、PaO2/FiO2随着EPAP的增高而逐渐增加，当EPAP增加至10 cm H2O时PaO2 、PaO2/FiO2达最大值(P<0.05)；与对照组比较PIP明显降低 (t=7.831，P=0.000)。 结论 对ALI/急性呼吸窘迫综合征(ARDS)患者给予双水平正压通气治疗可减少对呼吸和血流动力学的影响,在不影响血流动力学的前提下可降低PIP，缩短气管内插管及住院时间。
Abstract:
 Objective To investigate the effect of bilevel ventilation mode on blood gas and hemodynamics of patients with acute lung injury (ALI) by pulse indicator continuous cardiac output(PiCCO), and the clinical effect of this new ventilation mode on patients with ALI as well as its influence degree of circulatory system so that the cure rate of ALI can be improved. Methods There were 42 patients with ALI, 27 male and 15 female aged 15-75 years. According to the order of hospitalization, 40 patients (2 patients did not complete the study) were divided into two groups with 20 patients in each group. Bilevel ventilation group included the first 20 admitted patients. They were given bilevel ventilation support, using Support/Time(S/T) mode. The initial set of end inspiratory pressure (IPAP) was 8-10 cm H2O gradually increased to 14-20 cm H2O, which should be comfortable and appropriate for patients. The initial set of end expiratory pressure (EPAP) was 3-5 cm H2O gradually increased to 8-12 cm H2O. Fraction of inspired oxygen(FiO2) unchanged. Control group included the rest 20 admitted patients. They were given respiratory support, using Auxiliary/Control(A/C) mode followed by an increased positive endexpiratory pressure (PEEP) of 5 cm H2O,10 cm H2O,15 cm H2O,20 cm H2O. Each pressure kept 30 min. FiO2 unchanged. Indexes such as cardiac output (CO), systemic vascular resistance (SVR) etc were observed in both groups. Results There were 13 deaths in two groups, including 5 in bilevel ventilation group and 8 in control group. Seven cases died of multiple organ failure, 3 died of septic shock and 3 died of circulatory failure. Endotracheal intubation time (2.9±0.8 d vs. 4.2±0.9 d, t=7.737, P=0.006) and hospital stay (17.2±4.5 d vs. 18.5±3.6 d, t=2.558, P=0.039) in bilevel ventilation group were significantly shorter than those in control group. In control group, when PEEP ranged from 5 cm H2O to 15 cm H2O, arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2) gradually increased as PEEP increased (P<0.05); when PEEP increased to 20 cm H2O, CO decreased, SVR, pulmonary vascular resistance (PVR) and airway peak pressure (PIP) increased than those in range of 515 cm H2O (P<0.05). In bilevel ventilation group, PaO2 and PaO2/FiO2 gradually increased as EPAP increased. When EPAP increased to 10 cm H2O, PaO2 and PaO2/FiO2 increased to the maximum (P<0.05); PIP was significantly lower than that in control group (t=7.831, .P.=.0.000). Conclusion Giving bilevel ventilation treatment to patients with ALI/acute respiratory distress syndrome(ARDS) can reduce the effects on respiratory and hemodynamic. PIP and the time of endotracheal intubation and hospital stay can be reduced without affecting hemodynamics.

参考文献/References

备注/Memo

备注/Memo:
更新日期/Last Update: 2009-12-29