吸痰后高呼气末正压肺复张对严重脓毒症患者血流动力学及呼吸力学的影响研究

发布时间：2018-08-26 13:35

【摘要】：目的探讨吸痰后进行高呼气末正压(PEEP)肺复张对严重脓毒症致呼吸衰竭患者的血流动力学和呼吸力学指标的影响。方法前瞻性选择2010年1月—2012年6月中国医科大学附属第一医院急诊科重症监护室(EICU)行机械通气的基础疾病为严重脓毒症且并发Ⅰ型呼吸衰竭的患者118例,按照随机数字表法分为A、B两组,采用自身交叉对照的方法,A组(n=56)首先采用压力控制通气(PCV)模式然后用容量控制通气(VCV)模式,B组(n=62)则与之相反,均行开放式吸痰,每次吸痰结束后立即采取增加PEEP至20 cm H2O(1 cmH2O=0.098 kPa)持续40 s的方法进行肺复张。比较PCV模式和VCV模式下不同时间点呼吸力学和血流动力学指标的变化。结果在PCV和VCV模式下,肺复张前及肺复张后1、3 min时,患者心率均较基础水平加快、平均动脉压(MAP)降低(P0.05),肺复张后5、10、30 min时均恢复至基础水平(P0.05)。在PCV模式下,肺复张后1、30 min时潮气量较肺复张前分别增加43.8%、35.9%,总动态顺应性(Crs)较肺复张前分别增加42.0%、34.3%(P0.05)。在VCV模式下,肺复张后1、30 min时气道峰压较肺复张前分别降低24.3%、22.0%,气道平台压较肺复张前分别降低25.1%、24.4%,Crs较肺复张前分别增加33.5%、37.7%(P0.05)。结论对行机械通气的严重脓毒症患者吸痰后采取高PEEP法肺复张可引起心率和MAP的短暂变化,在PCV和VCV模式下均能够改善患者呼吸系统的Crs。
[Abstract]:Objective to investigate the effects of high positive end-expiratory pressure (PEEP) on hemodynamics and respiratory mechanics in patients with respiratory failure caused by severe sepsis after sputum aspiration. Methods 118 patients with severe sepsis complicated with type I respiratory failure were prospectively selected from January 2010 to June 2012 in (EICU) intensive care unit of the first affiliated Hospital of China Medical University. According to the random number table method, we divided group A into two groups. Group A (NN56) first adopted pressure controlled ventilation (PCV) mode and then volume controlled ventilation (VCV) mode (NN62), which was the opposite of group B, which was treated with open sputum aspiration. At the end of each sputum aspiration, pulmonary retension was performed by increasing PEEP to 20 cm H2O (1 cmH2O=0.098 kPa) for 40 s. The changes of respiratory mechanics and hemodynamics at different time points in PCV model and VCV model were compared. Results under the PCV and VCV models, the heart rate of the patients was faster than the basic level and the mean arterial pressure (MAP) was decreased (P0.05) before and 1 min after the retraction (P0.05), and recovered to the basic level (P0.05) at 510 ~ 30 min after pulmonary retraction. In PCV mode, the tidal volume increased by 43.835. 9 at 30 min after pulmonary retraction, and the total dynamic compliance (Crs) increased by 42. 0% or 34. 3% (P0.05). In VCV mode, the peak airway pressure was reduced by 24.3% and 22.0 at 30 min after lung reopening, and the airway plateau pressure was decreased by 25.1g / L and 24.4cm / L, respectively, and increased by 33.5% (P0.05). Conclusion the short term changes of heart rate and MAP in severe sepsis patients undergoing mechanical ventilation induced by Zhang Ke with high PEEP after sputum aspiration can improve the Crs. of respiratory system in both PCV and VCV models.
【作者单位】：中国医科大学附属第一医院急诊科;
【分类号】：R563.8

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