上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (12): 1477-.doi: 10.3969/j.issn.1674-8115.2010.12.007

• 专题报道（创伤医学） • 上一篇    下一篇

适应性支持通气伴肺复张策略对急性呼吸窘迫综合征的治疗效果

秦宗和, 应佑国, 茆 勇   

  1. 上海交通大学 医学院附属第三人民医院重症监护室 创伤医学研究所, |上海 201900
  • 出版日期:2010-12-25 发布日期:2010-12-31
  • 作者简介:秦宗和（1964—）, 男, 主任医师；电子信箱: qinzonghe123456@sohu.com。

Effects of adaptive support ventilation plus lung recruitment maneuvers on acute respiratory distress syndrome

QIN Zong-he, YING You-guo, MAO Yong   

  1. Intensive Care Unit, The Third People's Hospital, Institute of Traumatic Medicine, Shanghai Jiaotong University School of Medicine, Shanghai 201900, China
  • Online:2010-12-25 Published:2010-12-31

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摘要：

目的 评价适应性支持通气（ASV）模式加肺复张策略（LRM）在急性呼吸窘迫综合征（ARDS）患者中的效果。方法 收集创伤后合并ARDS的患者28例，先采用间歇正压通气（IPPV）模式维持8 h后，随机选择ASV或继续IPPV机械通气。选择ASV通气模式时，其分钟通气量设置应与IPPV时相同。通气时，两种模式下的呼气末正压(PEEP)均按0、5、10 cmH2O依次增加，每一PEEP的通气时间为60 min。ASV通气模式时，在每一PEEP水平加用LRM（ASV+LRM模式）。前一通气模式使用3 h后，将通气模式调为IPPV，PEEP调到0；1 h后换另一种模式。每个PEEP水平通气50 min时，用Swan-Ganz导管、心电监测仪、呼吸机监测记录患者的血流动力学、呼吸力学和氧代谢指标。结果 在同一PEEP水平下，ASV+LRM模式与IPPV模式相比较，血流动力学参数差异无统计学意义（P>0.05）；但在ASV+LRM模式时，同一PEEP水平下气道峰值压（PIP）降低，差异有统计学意义（P<0.05）；当PEEP为5 cmH2O时，肺动态顺应性、动脉氧分压和氧供均增加，差异也有统计学意义（P<0.05）。结论 ASV+LRM模式比IPPV模式更有利于ARDS患者的通气治疗。

关键词: 呼吸窘迫综合征, 间歇正压通气, 适应性支持通气, 肺复张策略

Abstract:

Objective To investigate the effects of adaptive support ventilation (ASV) plus lung recruitment maneuvers (LRM) on acute respiratory distress syndrome (ARDS). Methods Twenty-eight patients with ARDS after trauma were collected, and were randomly treated with ASV or intermittent positive pressure ventilation (IPPV) after management with IPPV for 8 h. The minute ventilation in ASV was the same with IPPV. Positive end expiratory pressure (PEEP) level increased in each model by 0, 5 and 10 cmH2O, and each level of PEEP was maintained for 60 min. LRM was added to each PEEP level in ASV model (ASV+LRM model). Three hours after the previous ventilation model, it was adjusted to IPPV with 0 cmH2O PEEP, then to the other model 1 h later. Hemodynamics, respiratory mechanics and oxygen metabolism parameters were measured with Swan-Ganz catheter, electrocardiogram monitor and breathing machine after patients were ventilated with each level of PEEP for 50 min. Results Under the same PEEP level, there was no significant difference in hemodynamic parameters between ASV+LRM model and IPPV model (P>0.05), while the peak inspiratory pressure in ASV+LRM model was significantly lower than that in IPPV model (P<0.05), and lung dynamic compliance, partial pressure of oxygen in artery and oxygen delivery in ASV+LRM model were significantly higher than those in IPPV model with PEEP=5 cmH2O (P<0.05). Conclusion ASV+LPS model is better than IPPV in ventilation for patients with ARDS.

Key words: respiratory distress syndrome, intermittent positive pressure ventilation, adaptive support ventilation, lung recruitment maneuvers