肺复张手法对急性呼吸窘迫综合征患者呼吸力学和血管外肺水指数的影响。
Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome.
机构信息
ICU, People's Hospital of Linyi, Linyi 276000, China (Zhang JG, Chen XJ) ICU, First Affiliated Hospital of Nanchang University, Nanchang 330006, China (Liu F, Zeng ZG, Qian KJ).
出版信息
World J Emerg Med. 2011;2(3):201-5. doi: 10.5847/wjem.j.1920-8642.2011.03.008.
BACKGROUND
Animal experiments showed that recruitment maneuver (RM) and protective ventilation strategy of the lung could improve oxygenation and reduce extravascular lung water. This study was to investigate the effects of RM on respiratory mechanics and extravascular lung water index (EVLWI) in patients with acute respiratory distress syndrome (ARDS).
METHODS
Thirty patients with ARDS were randomized into a RM group and a non-RM group. In the RM group, after basic mechanical ventilation stabilized for 30 minutes, RM was performed and repeated once every 12 hours for 3 days. In the non-RM group, lung protective strategy was conducted without RM. Oxygenation index (PaO2/FiO2), peak inspiratory pressure (PIP), Plateau pressure (Pplat), static pulmonary compliance (Cst) and EVLWI of patients before treatment and at 12, 24, 48, 72 hours after the treatment were measured and compared between the groups. Hemodynamic changes were observed before and after RM. One-way ANOVA, Student's t test and Fisher's exact test were used to process the data.
RESULTS
The levels of PaO2/FiO2 and Cst increased after treatment in the two groups, but they were higher in the RM group than in the non-RM group (P<0.05). The PIP and Pplat decreased after treatment in the two groups, but they were lower in the RM group than in the non-RM group (P<0.05). The EVLWI in the two groups showed downward trend after treatment (P<0.05), and the differences were signifcant at all time points (P<0.01); the EVLWI in the RM group was lower than that in the non-RM group at 12, 24, 48 and 72 hours (P<0.05 or P<0.01). Compared with pre-RM, hemodynamics changes during RM were significantly different (P<0.01); compared with pre-RM, the changes were not significantly different at 120 seconds after the end of RM (P>0.05).
CONCLUSIONS
RM could reduce EVLWI, increase oxygenation and lung compliance. The effect of RM on hemodynamics was transient.
背景
动物实验表明，肺复张手法（RM）和保护性肺通气策略可改善氧合并减少血管外肺水。本研究旨在探讨 RM 对急性呼吸窘迫综合征（ARDS）患者呼吸力学和血管外肺水指数（EVLWI）的影响。
方法
将 30 例 ARDS 患者随机分为 RM 组和非 RM 组。RM 组在基础机械通气稳定 30 分钟后进行 RM，每 12 小时重复 1 次，共 3 天。非 RM 组在无 RM 的情况下进行肺保护性策略。测量并比较两组患者治疗前及治疗后 12、24、48、72 小时的氧合指数（PaO2/FiO2）、吸气峰压（PIP）、平台压（Pplat）、静态肺顺应性（Cst）和 EVLWI。观察 RM 前后血流动力学变化。采用单因素方差分析、Student's t 检验和 Fisher 确切概率法对数据进行处理。
结果
两组患者治疗后 PaO2/FiO2 和 Cst 水平升高，但 RM 组高于非 RM 组（P<0.05）。两组患者治疗后 PIP 和 Pplat 降低，但 RM 组低于非 RM 组（P<0.05）。两组患者治疗后 EVLWI 呈下降趋势（P<0.05），各时间点差异均有统计学意义（P<0.01）；RM 组治疗 12、24、48、72 小时时 EVLWI 均低于非 RM 组（P<0.05 或 P<0.01）。RM 时血流动力学变化与 RM 前比较差异有统计学意义（P<0.01）；RM 结束后 120 秒时与 RM 前比较差异无统计学意义（P>0.05）。
结论
RM 可降低 EVLWI，增加氧合和肺顺应性。RM 对血流动力学的影响是短暂的。
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