【摘要】 目的在小潮气量(VT)机械通气的基础上,观察应用肺复张法(RM)治疗急性呼吸窘迫综合征(ARDS)的临床疗效,为临床RM的使用提供依据。方法选择2003年1月—2004年3月北京复兴医院重症监护治疗病房(ICU)收治的28例ARDS患者,随机分为小VT+RM组(RM组)和小VT组(nonRM组)。第一个24h采用容量控制通气(CMV),24h后根据病情选择机械通气方式。VT6ml/kg;尽可能在吸入氧浓度(FiO2)<0.60时达目标氧合的最小呼气末正压(PEEP)水平,限制平台压≤30cmH2O(1cmH2O=0.098kPa)。RM为吸入纯氧,持续气道正压(CPAP)40cmH2O,持续40s,8h1次,共5d。除RM外,其他治疗相同。记录基础状态和连续5d的机械通气参数、血气分析结果及生命体征,比较两组氧合改善和肺损伤指标变化,观察RM的不良反应和气压伤发生率。结果1两组动脉血氧分压和氧合指数(PaO2/FiO2)均明显改善,差异有显著性(P均<0.05)。2两组白细胞介素6(IL6)水平均呈下降趋势,RM组下降幅度更明显,差异有显著性(P<0.05)。3两组均无气压伤发生。4RM后心率无明显变化,也无其他心律失常发生;平均动脉压也无明显波动。结论反复多次RM可增加气体交换,改善氧合,进一步减少呼吸机相关性肺损伤(VALI)。应用RM较安全,简便易行,耐受性好,临床观察未见低氧血症和对血流动力学的明显影响。更多还原

【Abstract】 Objective To assess the effects of recruitment maneuvers （RMs） with low tidal volume（V_T） ventilation on gas oxygenation and reduction of ventilationassociated lung injury （VALI） in patients suffering from acute respiratory distress syndrome （ARDS）, to assess the effects of RMs on blood pressure, heart rate and occurrence of barotrauma. Methods Patients in intensive care unit （ICU） of Beijing Fuxing Hospital were randomized into two groups: low V_T +RM group and low V_T without RM group （nonRM group）. Twentyeight patients with early ARDS admitted from January 2003 to March 2004 were enrolled in the study. All patients received protective ventilation: V_T was set at 6 ml/kg with plateau pressure limited at 30 cm H₂O （1 cm H₂O=0.098 kPa） or lower, positive endexpiratory pressure （PEEP） and fraction of inspired oxygen （FiO₂） were set to obtain an partial pressure of arterial oxygen （PaO₂） between 60 to 80 mm Hg（1 mm Hg=0.133 kPa）. RMs were conducted by regulating FiO₂ to 1.00, applying 40 cm H₂O of continuous positive airway pressure （CPAP） for 40 seconds, and then resumed the previous ventilator settings （mode, PEEP, and FiO₂）. This modality was repeated once every 8 hours for a total of 5 days. Measurements of PaO₂/FiO₂, serum interleukin6 （IL6） concentration, respiratory and radiographic data, ventilatory parameters were obtained at baseline and for the first 5 days . Mean arterial pressure and heart rate and pulse oxygen saturation （SpO₂） were measured before and after the RM. The primary outcome was mortality at 28 days. Results ①After RM, PaO₂/FiO₂ and PaO₂ in RM group and nonRM group increased, but the values were higher in RM group, and the difference between two groups was significant （all P<0.05）. ② IL6 concentrations decreased in both groups but lower in RM group with significant difference （P<0.05）. ③ Barotrauma did not occurr in both groups. ④No significant changes in blood pressure and heart rate were found during RMs. HR and MAP remained unchanged after RM. Conclusion RM could recruit the collapsed alveoli in ARDS. It could significantly improve oxygenation and decrease VALI. A superimposed RM is safe, and repeated RM could also decrease barotrauma.更多还原