Trojik Tatjana, Shosholcheva Mirjana, Radulovska-Chabukovska Jasmina, Lovach-Chepujnoska Margita
University Clinic for surgical diseases of "St. Naum Ohridski", Skopje R Macedonia ; University Clinic for surgical diseases of "St. Naum Ohridski", Skopje R Macedonia ; University Clinic for surgical diseases of "St. Naum Ohridski", Skopje R Macedonia.
Acta Inform Med. 2012 Jun;20(2):85-9. doi: 10.5455/aim.2012.20.85-89.
acute respiratory failure is manifested clinically as patient with variable degrees of respiratory distress, but characteristically an abnormal arterial blood partial pressure of oxygen or carbon dioxide. The application of mechanical ventilation in this setting can be life saving.
The aim of this study is to evaluate the effects of two recruitment maneuvers not only on oxygenation, but on aeration of the lung as well. For that purpose chest x ray and thoracic computed tomography scan (CT) of the lung were used as safe and objective methods for evaluation the impact of recruitment maneuvers on aeration of the lung. CT scan and chest x ray were performed before recruitment maneuvers as confirmation of diagnose and one day after the last recruitment maneuvers.
Sixty patients who met ar DS criteria of the american european consensus conference were included in this study. This study was conducted in iCU in our hospital between november 2009 and December 2011. Patients were orally intubated, sedated with 0, 2-0, 4 μg/kg /min and midazolam 4 mg/h, and ventilated with evita 2 Dura ventilator (Dragger germany). According to the recom-mendation of the Consensus Conference of the american College of Chest physician all patients had an arterial catheter and cen-tral venous catheter. Hemodynamic data were collected from Data Ohmeda monitors. Gas analyses were mesured from blood samples taken from arteria radialis. Partial pressure of oxygen of mixed blood was messured from blood sample taken from v jugularis interior. We used arterial blood colection syringe Bd preset, and blood samples were analyzed with aVl 995HB blood gas analiser.
HEMODYNAMIC CHANGES: there wasn't any differences in heart rate, and mean arterial blood pressure before the recruitment five minutes and sixty minutes after the recruitment in both groups. respiratory mechanics: Highest values of the compliance are achived during the recruitment manouver in both groups. There was better improvment in compliance during the e sigh recruitment maneouver, then in Cpap recruitment maneouver. There was improvement in chest X ray in both groups. 93,4% of patients in the Cpap group and 96,7% in e sigh group. CT scan: in Cpap group there were 8 patients with focal changes and 22 patients with diffusse changes. in e sigh group 29 patients had diffuse changes of the lung and one patient had focal changes. We noticed that there was better improvment in aeration in patients with diffuse changes of the lung 96.7% in e sigh group and 73,3% in Cpapgroup. In patient with focal changes there was improvment in 26,7% in e sigh group and 3,3% in Cpap group. We noticed that there was better improvmnet in aeration in patients with diffuse changes than in patients with focal changes. E sigh maneuver had better impact on aeration of the lung then Cpap recruitment maneuver.
In our study we proved that e sigh recruitment maneuvers better improved oxygenation in arterial blood than Cpap recruitment maneuver. Repetative e sigh manouvers proved to be essential for arDS patients. They reopened collapsed alveolli and improved aeration of the lung which was confirmed by X ray and CT scan as an objective methods for verification of lung condition.
急性呼吸衰竭在临床上表现为患者有不同程度的呼吸窘迫，但典型表现为动脉血氧分压或二氧化碳分压异常。在此情况下应用机械通气可能挽救生命。
本研究的目的是评估两种肺复张手法不仅对氧合，而且对肺通气的影响。为此，胸部X线和胸部计算机断层扫描（CT）被用作评估肺复张手法对肺通气影响的安全且客观的方法。在肺复张手法前进行CT扫描和胸部X线检查以确诊，在最后一次肺复张手法后一天再次进行。
60例符合欧美共识会议急性呼吸窘迫综合征（ARDS）标准的患者纳入本研究。本研究于2009年11月至2011年12月在我院重症监护病房进行。患者经口插管，以0.2 - 0.4μg/kg/min的丙泊酚和4mg/h的咪达唑仑镇静，并使用德国德尔格Evita 2 Dura呼吸机通气。根据美国胸科医师学会共识会议的建议，所有患者均留置动脉导管和中心静脉导管。血流动力学数据从Date Ohmeda监护仪收集。气体分析通过从桡动脉采集的血样进行测量。混合静脉血氧分压通过从颈内静脉采集的血样进行测量。我们使用预设的Bd动脉采血注射器，血样用AVL 995HB血气分析仪进行分析。
血流动力学变化：两组在肺复张前5分钟和肺复张后60分钟的心率和平均动脉血压均无差异。呼吸力学：两组在肺复张操作期间顺应性均达到最高值。在叹息样肺复张操作期间顺应性改善优于持续气道正压（CPAP）肺复张操作。两组胸部X线均有改善。CPAP组93.4%的患者、叹息样组96.7%的患者改善。CT扫描：CPAP组有8例患者有局灶性改变，22例患者有弥漫性改变。叹息样组29例患者有肺部弥漫性改变，1例患者有局灶性改变。我们注意到肺部有弥漫性改变的患者通气改善更好，叹息样组为96.7%，CPAP组为73.3%。有局灶性改变的患者中，叹息样组改善率为26.7%，CPAP组为3.3%。我们注意到肺部有弥漫性改变的患者通气改善优于有局灶性改变的患者。叹息样手法对肺通气的影响优于CPAP肺复张手法。
在我们研究中，我们证明叹息样肺复张手法比CPAP肺复张手法能更好地改善动脉血氧合。重复性叹息样手法对ARDS患者至关重要。它们重新开放塌陷的肺泡并改善肺通气，这通过X线和CT扫描得到证实，X线和CT扫描是用于验证肺部情况的客观方法。
