【摘要】 目的探讨以高频震荡通气(HFOV)与持续气道正压(CPAP)通气两种模式实施肺复张策略治疗急性呼吸窘迫综合征(ARDS)对患者血流动力学、肺损伤指标、氧代谢指标及气压伤的影响。方法选择ARDS行机械通气及有创持续血流动力学监测的患者20例,随机实施HFOV或CPAP模式肺复张,每隔4h复张1次,每次持续40s。HFOV组实施持续肺充气(SI),先将平均气道压(MAP)调至比常规机械通气时的MAP高2cm H2O,将MAP快速升高至35cm H2O,持续40s后回到SI前的水平。CPAP组呼气末正压(PEEP)在10s内升至35cmH2O,持续40s,于5s内PEEP降至10cm H2O,恢复基础通气模式。记录复张前后的肺损伤指标白细胞介素-6(IL-6)、氧合指数(PaO2/FiO2),以及复张时的心排指数(CI)、中心静脉压(CVP)等血流动力学变化。结果两组PaO2/FiO2均明显改善,而HFOV模式更为明显,差异有显著性(P均<0·05)。IL-6水平均呈下降趋势,HFOV组下降幅度更明显,差异有显著性(P均<0·05)。行肺复张时两组CI均轻度下降,CVP均轻度增加。HFOV组复张第20s CVP开始升高,并维持高水平至复张后30s,复张第40s时CVP值与复张前比较差异有显著性(P<0·05);CI在复张第20s开始下降,第40s下降值与复张前比较差异有显著性(P<0·05),于停止复张后60s基本恢复至复张前水平。CPAP组CI及CVP出现相似变化,但在第20s即出现显著差异(P<0.05),并于停止复张后120s基本恢复至复张前水平。两组均无气压伤发生。结论肺复张策略对于ARDS的机械通气治疗是一种安全、有效的方法,采用HFOV模式进行ARDS肺复张治疗对血流动力学的干扰、肺的损伤及氧合的改善优于CPAP模式。更多还原

【Abstract】 Objective To evaluate the effects of high-frequency oscillatory ventilation（HFOV） vs continuous positive airway pressure（CPAP） on hemodynamics,lung injury and oxygenation in acute respiratory distress syndrome（ARDS） patients.Methods Twenty ARDS patients ventilated and monitored by the pulse contour method（PiCCO） were randomized into HFOV group and CPAP group,and lung recruitment maneuver（RM） was executed 40 seconds every 4 hours.In the HFOV group,sustained inflation was conducted,and at first the mean airway pressure（MAP） was keeped at 2 cm H₂O（FiO₂ of 1.0） higher than the level of routine machanical ventilation,then the MAP was raised to 35 cm H₂O quickly.In the CPAP group,the CPAP was also 35 cm H₂O（FiO₂ of 1.0）. Before and after RM,the parameters of lung injury,oxygen metabolism index and hemodynamics were monitored.Results The parameters of lung mechanics and oxygenation were improved significantly in both groups but were better in HFOV group than CPAP group（P<0.05）.Serum interleukin-6 level decreased in both groups but more obvious in HFOV group（P<0.05）.Barotrauma occurred in neither groups.Cardiac index decreased and CVP increased slightly during RM with short duration in both groups but the changes were milder in HFOV group.Conclusions A superimposed RM is a effective and safe strategy.HFOV is superior to CPAP in improving lung injury and oxygenation and maintaining hemodynamics stability.更多还原