| 李育明,周秋香,江伟伟,吴 昊,单红卫.呼气末正压滴定方式对急性呼吸窘迫综合征伴腹腔高压患者呼吸功能的影响研究[J].,2017,17(18):3583-3587 |
| 呼气末正压滴定方式对急性呼吸窘迫综合征伴腹腔高压患者呼吸功能的影响研究 |
| Effects of Positive end Expiratory Pressure Titration on the Respiratory Function of Patients with Acute Respiratory Distress Syndrome Associated with Abdominal Hypertension |
| 投稿时间：2016-11-24 修订日期：2016-12-15 |
| DOI：10.13241/j.cnki.pmb.2017.18.043 |
| 中文关键词: 急性呼吸窘迫综合征 腹腔高压 呼气末正压滴定 跨肺压导向滴定 压力-容积导向滴定 呼吸功能 |
| 英文关键词: Acute respiratory distress syndrome Abdominal hypertension Positive end expiratory pressure titration Cross lung pressure directed titration Pressure volume directed titration Respiratory function |
| 基金项目:上海市卫生局科技项目（上卫2012-274） |
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| 中文摘要: |
| 摘要 目的：观察呼吸末正压(Positive end expiratory pressure，PEEP)不同滴定方法对急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)伴腹腔高压(Intra abdominal hypertension，IHA)患者呼吸功能的影响，为ARDS伴IHA患者临床治疗呼气末正压滴定方案选择提供参考。方法：选择2015年1月-2016年1月我院ICU接受治疗的64例ARDS合并IHA患者，所有患者均性机械通气治疗，对患者的呼气末正压进行控制，按照PEEP滴定方式的不同将其分为两组，跨肺压牵张指数导向滴定组32例设为A组，肺静态压力-容积(P-V)曲线低位转折点压力导向滴定组32例设为B组。比较两组患者PEEP滴定前、PEEP滴定1d后的呼吸功能相关指标(pH值、氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(PaO2／FiO2)、潮气量(vt)、气道峰压(Ppeak)、气道平台压(Pplat)、呼气末正压(PEEPtot)、肺静态顺应性(Cst)，比较不同PEEP导向滴定对ARDS合并IHA患者呼吸功能的影响。结果：两组患者PEEP滴定前pH值、PaO2、PaCO2、PaO2／FiO2、vt、Ppeak、Pplat、PEEPtot、Cst比较差异均无统计学意义(P＞0.05)。两组患者PEEP滴定后1d pH值、PaO2、PaO2／FiO2、vt、Cst较PEEP前明显升高(P＜0.05)，PaCO2、Ppeak、Pplat、PEEPtot较PEEP前明显降低(P＜0.05)。但A组患者滴定后1d Cst、vt、PaO2／FiO2明显高于B组患者(P＜0.05)，组间其它指标比较差异无统计学意义(P＞0.05)。A组患者中Ⅲ级、Ⅱ级腹腔压力患者的Cst、vt、PaO2／FiO2改善幅度明显高于B组患者Ⅲ级、Ⅱ级腹腔压力患者(P＜0.05)。结论：跨肺压排除了胸壁顺应性的影响，对腹腔高压患者胸壁弹性阻力明显增加的情况下，指导PEEP滴定对Ⅱ级、Ⅲ级腹高压ARDS患者的呼吸功能改善效果更优，跨肺压导向PEEP滴定是治疗ARDS合并IHA患者更适合且有效的手段。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effect of positive end expiratory pressure (Positive end expiratory pressure, PEEP) of different titration methods on acute respiratory distress syndrome (acute respiratory distress syndrome ARDS (Intra abdominal) with abdominal pressure hypertension, IHA) in patients with respiratory function influence and provide references for the clinical treatment of ARDS patients with IHA in the treatment of positive end expiratory pressure titration. Methods: 64 cases of ARDA patients with IHA admitted in our hospital from January 2015 to January 2016 were selected treated with mechanical ventilation, positive end expiratory pressure control. The patients were divided into two groups according to the PEEP titration in different ways, 32 cases in group A were treated by transpulmonary pressure stretch index guide titration, 32 cases in the group B were treated by lung static pressure volume (P-V) curve predicts pressure titration. The respiratory function indexes of PEEP were compared between the two groups before and after 1D PEEP titration (the pH value, oxygen partial pressure (PaO2), partial pressure of carbon dioxide (PaCO2) and oxygenation index (PaO2/FiO2); tidal volume (VT), peak airway pressure (Ppeak), pplat (Pplat). Positive end expiratory pressure (PEEPtot), static pulmonary compliance (Cst). Results: No statistically significant difference was found in the pH values, PaO2, PaCO2, PaO2/FiO2, VT, Ppeak, Pplat, Cst, PEEPtot, and PEEP between the two groups before PEEP titration (P>0.05). The pH, PaO2, PaO2/FiO2, VT, Cst of both groups after 1 day PEEP titration were significantly increased than those before PEEP titration (P<0.05), the PaCO2, Ppeak, Pplat, PEEPtot were significantly lower (P<0.05). But the Cst VT, 1D, PaO2/FiO2 of group A after 1 day PEEP titration were significantly higher than those of group B (P<0.05), no statistically significant difference was found in the other indicators between two groups(P>0.05). The improvement of Cst, vt, PaO2／FiO2 of patients with grade III and grade II abdominal pressure in group A were significantly higher than those in group B(P＜0.05). Conclusion: The transpulmonary pressure eliminated the effect of chest wall compliance. In the case of chest wall elastic resistance of intra-abdominal hypertension patients increased obviously, guiding PEEP titration could clearly improve the respiratory function of grade II and III intra-abdominal hypertension ARDS patients. Transpulmonary pressure oriented PEEP titration was more suitable and effective way to incure patients with ARDS and IHA. |
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