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低潮气量加呼气末正压通气对急性肺损伤氧代谢的影响
Effect of low tidal volume with positive end-expiratory pressure on oxygen metabolism in patients with acute lung injury
【摘要】 目的 采用低潮气量加呼气末正压 (PEEP)通气 ,观察对急性肺损伤 (ALI)氧代谢的影响。方法 对 14例ALI患者 ,最初采用辅助 /控制 (A/C)通气 ,并逐渐增加PEEP ,每种方式 30min ,吸入氧浓度 (FiO2 )不变。利用Swan -Ganz导管获得氧代谢参数。结果 当PEEP 1 47kPa时 ,氧供给 (DO2 )最大 ,PEEP 1 96kPa时 ,DO2 下降(P <0 0 5 )。当PEEP在 0 49~ 1 47kPa范围内 ,对平均动脉压 (MBP)、肺动脉压 (PAP)和心脏射血指数 (CI)均无明显影响 (P >0 0 5 )。当PEEP增加到 1 96kPa时 ,CI降低。PEEP在 0 98和 1 47kPa时 ,肺静态顺应性 (Cst)稳定在 (33 6± 8 3)mL/cmH2 O水平 ,当PEEP 1 96kPa时 ,Cst下降 (P <0 0 5 )。结论 ALI采用低潮气量加适当PEEP可得到稳定的Cst,减少对血流动力学的影响 ,获得最大DO2 。
【Abstract】 Objective To explore the effect of low tidal volume with positive end-expiratory pressure(PEEP) on oxygen metabolism in 14 acute lung injury(ALI) patients.Methods 14 patients with ALI were optimally ventilated by Assist and Control(A/C),and PEEP was increased gradually for 30min,respectively.The concentration of FiO 2 was kept constant.The parameters of oxygen metabolism were obtained by using Swan-Ganz catheter.Resul