急性呼吸窘迫综合征患者呼气末正压治疗方案选择及对血液动力学影响
Selection of positive end expiratory pressure treatment and its influence on respiratory function and hemodynamics in patients with acute respiratory distress syndrome

马英霞.急性呼吸窘迫综合征患者呼气末正压治疗方案选择及对血液动力学影响[J].内科急危重症杂志,2019,25(2):136-138

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DOI：10.11768/nkjwzzzz20190214

中文关键词: 急性呼吸窘迫综合征 呼吸治疗 呼气末正压方案 呼吸功能 血液动力学 预后

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作者	单位	E-mail
马英霞	四川省攀钢集团总医院	zzyxjly666@163.com

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中文摘要:

目的：分析不同呼气末正压(PEEP）治疗方案对急性呼吸窘迫综合征(ARDS）患者呼吸功能和血液动力学的影响，为ARDS患者综合治疗方案选择提供参考。方法：选择ARDS患者86例，采用随机数字表法将其分为高PEEP组（PEEP＞12cm H2O）和低PEEP组（PEEP 8～10cm H2O），每组43例。2组患者均采用小潮气量（≤6 mL/kg）通气，均对症治疗原发疾病，控制液体量等治疗措施，均按照指南控制呼吸频率、平台压、动脉血氧分压(PaO2)及脉搏血氧饱和度(SpO2)。比较2组患者入组前、机械通气参数稳定后12、24 h血液动力学指标\[心率（HR）、肺动脉平均压（MPAP）、肺动脉楔压（PAWP）\]及呼吸功能指标差异\[pH值、PaCO2、氧合指数(Pa02／FiO2）\]。比较2组患者28d病死率。结果：2组患者性别、年龄、体质量指数（BMI）、ARDS发病时间、ARDS原发疾病比较差异无统计学意义（P＞0.05）。2组患者通气参数稳定后12、24 h的HR、MPAP、PAWP较入组前明显升高（P＜0.05），且高PEEP组升高幅度明显大于低PEEP组（P＜0.05）。pH值、Pa02／FiO2较入组前明显升高，PaCO2较入组前明显降低（P＜0.05），且高PEEP组Pa02／FiO2升高幅度明显大于低PEEP组（P＜0.05）。高PEEP组患者28d病死率低于低PEEP组（11.63% vs 18.60%，P＞0.05）。结论：高PEEP联合小潮气量的机械通气策略对于ARDS患者血液动力学指标产生更大的影响，可有效改善患者的呼吸功能，该通气策略对心功能良好的ARDS患者具有更高的临床价值。

英文摘要:

Objective: To analyze the effects of positive end expiratory pressure (PEEP) treatments on the respiratory function and hemodynamics of patients with acute respiratory distress syndrome (ARDS) and provide reference for selection of comprehensive treatment programs for patients with ARDS. Methods: A total of 86 ARDS patients who met the inclusion criteria were selected. The patients were divided into high PEEP group (PEEP>12 cmH2O) and low PEEP group (PEEP 8-10 cmH2O) by digital random table method, with 43 cases in each group. Two groups of patients were given low tidal volume ventilation (≤6 mL/kg). The respiratory rate, plateau pressure, arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation (SpO2) were controlled according to the guidelines in the two groups. Two groups of patients were subjected to the symptomatic treatment of primary diseases, control of liquid volume and other measures. Before entering the group, and 12 and 24 h after stabity of mechanical ventilation parameters, hemodynamic indexes including heart rate (HR), mean pulmonary arterial pressure (MPAP) and pulmonary artery wedge pressure (PAWP), and respiratory function indexes including pH value, carbon dioxide partial pressure (PaCO22), oxygenation index (PaO2/FiO2) were compared between two groups. The 28-day mortality was compared between the two groups. Results: There was no significant difference in gender, age, weight, body mass index (BMI), onset time of ARDS and ARDS primary disease between the two groups (P>0.05). At 12 and 24 h in both groups of patients with stabity of ventilation parameters, HR, MPAP and PAWP were significantly increased as compared with those before entering the groups (P< 0.05), more significantly in the high PEEP group than in the low PEEP group (P<0.05). At 12 and 24 h in two groups of patients with stabity of ventilation parameters, pH value and PaO2/FiO2 were significantly increased, and PaCO2 decreased significantly as compared with those before entering the group (P<0.05). The increase in PaO2/FiO2 in the PEEP group was more significant than in the low PEEP group (P<0.05). The mortality rate in the high PEEP group after ARDS was 11.63%, lower than that in the low PEEP group (18.60%), but there was no significant difference between two groups (P>0.05). Conclusion: PEEP combined with mechanical ventilation strategy in low tidal volume can exert the great impact on the hemodynamic indexes in patients with ARDS, but can effectively improve the respiratory function. This strategy has greater clinical value in the ARDS patients with good cardiac function.