【摘要】 目的研究肺开放策略对外科严重脓毒症引起的急性呼吸窘迫综合征(ARDS)患者氧输送的影响。方法选择外科严重脓毒症引起的ARDS患者30例,入院后均行早期目标指导治疗(EGDT),随机分成对照组和观察组各15例,对照组采用小潮气量保护性肺通气治疗,观察组采用小潮气量保护性肺通气结合肺开放治疗,采用脉搏指标剂连续心排量(PiCCo)监测两组血流动力学变化,观察肺开放对患者呼吸力学及氧输送的影响。结果 (1)肺开放后患者气道峰压(PIP)、平台压(Pplat)下降,肺静态顺应性(Cst)升高,在1、2、4、6 h两组PIP、Pplat、Cst比较差异有显著性(P<0.05或P<0.01);(2)患者氧输送在肺开放1、2、4 h后,两组比较差异有显著性(P<0.05或P<0.01),但肺开放结束6 h后,差异无显著性(P>0.05)。结论肺开放可以使外科严重脓毒症引起的ARDS患者肺泡复张,改善肺顺应性、增加氧输送,对外科严重脓毒症引起的ARDS患者行肺开放时间间隔不宜超过6 h。更多还原

【Abstract】 Objective To investigate the effects of open lung strategy on oxygen delivery in patients with severe surgical sepsis-induced acute respiratory distress syndrome.Methods Thirty patients with severe surgical sepsis-induced ARDS were enrolled,initially treated by Early Goal-Directed Therapy(EGDT) after admission,and randomly divided into two groups: Control group and Treatment group(n=15).The control group was treated with low tidal volume lung protective ventilation,while the treatment group was treated with low tidal volume lung protective ventilation combined with lung open strategy.Pulse index continuous cardiac output(PiCCo) was used to monitor hemodynamic changes for evaluation the respiratory mechanics and oxygen delivery in patients.Results(1) Significant reductions of Peak Inspiratory Pressure(PIP) and Platform Pressure,and increase of Static Lung Compliance(Cst) were observed in treatment group 1 hour(h),2 h,4h and 6h after opening lung.(2) Significant differences of oxygen delivery were also detected 1h,2h and 4h between the two groups,while no significant difference was revealed at 6h.Conclusion The open lung strategy can recruit the collapsed alveolus in patients with ARDS caused by severe surgical sepsis and significantly improve lung compliance and increase oxygen delivery.The open lung interval is preferred no more than 6 hours.更多还原