双水平正压通气对ARDS患者心肺保护作用.doc

双水平正压通气对ARDS患者心肺保护作用[摘要] 目的 探讨双水平正压（BIPAP）通气对ARDS患者的心肺保护作用。方法 对比观察双水平正压通气与同步间歇指令通气（SIMV）对ARDS患者氧合指数（Pao2/Fio2）、心排指数（CI）以及平均动脉压（MAP）的影响。结果 与同组通气前比较，两组机械通气后各时点Pao2/Fio2均显著提高（P均＜0.01），通气1h CI与MAP均显著降低（P均＜0.01），此后逐渐恢复；组间比较，BIPAP组通气24h与48h Pao2/Fio2（分别为203.96±7.04与275.31±6.24）较相同时点SIMV组（183.45±6.95与214.22±7.03）提高更为明显，差异具有统计学意义（P均＜0.01）；BIPAP组于通气1h与24h对CI、MAP的影响较SIMV组相同时点小，差异具有统计学意义（P均＜0.01），于48h则与相同时点SIMV组无显著性差异（P＞0.05）。结论 双水平正压通气有助于改善ARDS患者的Pao2/Fio2，同时对循环干扰较小，具有明显的心肺保护作用。 [关键词] 双水平气道正压通气； 同步间歇指令通气； ARDS [中图分类号] R563.8 [文献标识码] A [文章编号] 1673-9701（2009）13-01-03 Cardiopulmnary Protective Effects of Biphasic Positive Airway Pressure Ventilation in ARDS Patients JIANG Chunling ZHANG Weixing SUN Yue Department of ICU，Peking University Shenzhen Hospital，Shenzhen 518036 [Abstract] ObjectiveTo explore the cardiopulmnary protective effects of biphasic positive airway pressure ventilation in patients with acute respiratory distress syndrome（ARDS）. MethodsComparative study was used to observe the effects of biphasic positive airway pressure（BIPAP）ventilation and synchronized intermittent mandatory ventilation（SIMV）on index of oxygenation（Pao2/Fio2），cardiac output index（CI）and mean arterial pressure（MBP） of ARDS patients. ResultsAfter mechanical ventilation，the Pao2/Fio2 was both significantly increased in two groups，and the CI and MAP were all significantly decreased at 1h of ventilation in two groups，then gradually rised；after 24 h and 48h of BIPAP ventilation，the Pao2/Fio2 were 203.96±7.04 and 275.31±6.24 respectively，significantly higher than that of SIMV（P＜0.01），which were 183.45±6.95 and 214.22±7.03 respectively； and the reduction of CI and MAP at 1h and 24h in BIPAP group were less than that in SIMV group（P＜0.01）， but there was no significant difference at 48h between two groups. ConclusionBIPAP ventilation can not only help to improve Pao2/Fio2，but also has little adverse effect on circulation，then has significant cardiopulmnary protective effects in ARDS p