【摘要】：目的探討吸痰后進(jìn)行高呼氣末正壓(PEEP)肺復(fù)張對(duì)嚴(yán)重膿毒癥致呼吸衰竭患者的血流動(dòng)力學(xué)和呼吸力學(xué)指標(biāo)的影響。方法前瞻性選擇2010年1月—2012年6月中國(guó)醫(yī)科大學(xué)附屬第一醫(yī)院急診科重癥監(jiān)護(hù)室(EICU)行機(jī)械通氣的基礎(chǔ)疾病為嚴(yán)重膿毒癥且并發(fā)Ⅰ型呼吸衰竭的患者118例,按照隨機(jī)數(shù)字表法分為A、B兩組,采用自身交叉對(duì)照的方法,A組(n=56)首先采用壓力控制通氣(PCV)模式然后用容量控制通氣(VCV)模式,B組(n=62)則與之相反,均行開(kāi)放式吸痰,每次吸痰結(jié)束后立即采取增加PEEP至20 cm H2O(1 cmH2O=0.098 kPa)持續(xù)40 s的方法進(jìn)行肺復(fù)張。比較PCV模式和VCV模式下不同時(shí)間點(diǎn)呼吸力學(xué)和血流動(dòng)力學(xué)指標(biāo)的變化。結(jié)果在PCV和VCV模式下,肺復(fù)張前及肺復(fù)張后1、3 min時(shí),患者心率均較基礎(chǔ)水平加快、平均動(dòng)脈壓(MAP)降低(P0.05),肺復(fù)張后5、10、30 min時(shí)均恢復(fù)至基礎(chǔ)水平(P0.05)。在PCV模式下,肺復(fù)張后1、30 min時(shí)潮氣量較肺復(fù)張前分別增加43.8%、35.9%,總動(dòng)態(tài)順應(yīng)性(Crs)較肺復(fù)張前分別增加42.0%、34.3%(P0.05)。在VCV模式下,肺復(fù)張后1、30 min時(shí)氣道峰壓較肺復(fù)張前分別降低24.3%、22.0%,氣道平臺(tái)壓較肺復(fù)張前分別降低25.1%、24.4%,Crs較肺復(fù)張前分別增加33.5%、37.7%(P0.05)。結(jié)論對(duì)行機(jī)械通氣的嚴(yán)重膿毒癥患者吸痰后采取高PEEP法肺復(fù)張可引起心率和MAP的短暫變化,在PCV和VCV模式下均能夠改善患者呼吸系統(tǒng)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.
【作者單位】： 中國(guó)醫(yī)科大學(xué)附屬第一醫(yī)院急診科;
【分類(lèi)號(hào)】：R563.8

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