Simon R J, Mawilmada S, Ivatury R R
Department of Surgery, New York Medical College, Lincoln Medical and Mental Health Center, Bronx 10451.
J Trauma. 1994 Jul;37(1):74-80; discussion 80-1.
Concern that barotrauma may lead to further deterioration in pulmonary function in patients with ARDS has stimulated interest in developing methods of reducing it. These new modalities have had limited acceptance. The reasons for this include technical difficulties, associated complications, and the hypercapnia produced by the reduction in minute ventilation associated with diminished peak inspiratory pressure (PIP). Recent reports have shown that hypercapnia does not produce many of the adverse effects previously attributed to it. We studied the effects of moderate levels of hypercapnia produced by inverse ratio ventilation with low tidal volumes in patients with severe pulmonary dysfunction (Lung Injury Score > or = 2.5). The mean peak PaCO2 and PIP of the group were 63.3 +/- 15.7 mm Hg and 44.0 +/- 12.4 cm H2O, respectively. We found no adverse effects on cardiac function, oxygen utilization, or long-term neurologic function in patients after hypercapnia. We conclude that moderate levels of hypercapnia are safe, and may be permitted in the care of patients with severe pulmonary dysfunction.
气压伤可能导致急性呼吸窘迫综合征（ARDS）患者肺功能进一步恶化，这一担忧激发了人们对开发降低气压伤方法的兴趣。这些新方法的接受程度有限。其原因包括技术难题、相关并发症以及与吸气峰压（PIP）降低相关的分钟通气量减少所导致的高碳酸血症。近期报告显示，高碳酸血症并未产生许多先前归因于它的不良反应。我们研究了低潮气量反比通气在严重肺功能障碍（肺损伤评分≥2.5）患者中产生的中度高碳酸血症的影响。该组的平均动脉血二氧化碳分压（PaCO2）峰值和PIP分别为63.3±15.7 mmHg和44.0±12.4 cmH2O。我们发现高碳酸血症后患者的心脏功能、氧利用或长期神经功能均未受到不良影响。我们得出结论，中度高碳酸血症是安全的，在严重肺功能障碍患者的护理中可能是允许的。
