肺复张手法治疗急性呼吸窘迫综合征患者的临床分析word格式论文.docxVIP

肺复张手法治疗急性呼吸窘迫综合征患者的临床研究中文摘要目的：探讨肺复张策略(RM) 同小潮气量通气模式相结合对急性肺损伤 (ALI)/急性呼吸窘迫综合征（ARDS）患者的肺复张作用及其对血流动力学的影响。方法： 2010年11月至2011年10月之间因各种因素导致ALI/ARDS入住ICU的病 人14例，入住ICU后以小潮气量（6-8ml/kg）基础通气1小时后进行RM共计20次， 应用压力控制法(PCV)25cmH20，呼气末正压(PEEP)20cmH2O保持1分钟，观察RM前、 RM后15分、RM后1小时、RM后2小时动脉血气指标、血流动力学指标以及呼吸力学 指标。结果：与复张前比较,复张后动脉血气分析、动脉氧分压及氧合指数均有提 高,15min、1 h、2 h 提高有统计学意义( P 0.05) ;二氧化碳分压、PH值无明显变 化( P 0.05) ;气道峰压、平均气道压在肺复张后1h、2h明显升高 ( P 0.05) ,呼 吸系统顺应性和平台压在复张后明显提高( P 0.05) ;中心静脉压、心率在复张过 程中提高( P 0.05) ,心排量、平均动脉压复张过程中下降，但复张后15min及以 后与治疗前比较没有明显变化( P 0.05) 。结论：在肺保护性通气策略的基础上应用肺复张手法可以改善ARDS患者的氧 合、提高肺的顺应性、对血流动力学的影响短暂。关键词：急性呼吸窘迫综合征 肺复张手法The study on effects of Lung Recruitment Maneuvers inPatients with Acute Respiratory Distress SyndromeAbstractobjective： To investigate the clinical effects and safety of recruitment maneuvers (RM) combined with lung protective strategy in patient s with acute respiratory distress syndrome (ARDS).Methods：Twenty acute respiratory distress syndrome(ARDS) patients caused by multiple diseases in intensive care unit(ICU)were enrolled in this study from November 2010 to October 2011.Twenty ventilated patients with ARDS underwent RM using a pressure of 45 cmH2O for 60s ,without any neuromuscular blocking agent.Results ：After RM treatment ,both oxygenation index and partial pressure of arterial oxygen(PaO2) were significantly increased in 15min 、1 hr and 2 hr ( P 0.05) . There was no significant difference in the partial pressure of carbon dioxide (PaCO2 ) and PH value before and after RM( P 0.05).The peak inspiratory pressures (PIP) and mean airway pressure（Pm）had no significant difference between after and before RM( P 0.05) , but respiratory system compliance (Crs) and plateau inspiratory pressure increased markedly after RM ( P 0.05) .The central vein pressure (CVP) and heart rate(HR) increased duringrecruitment ( P 0.05) ,The cardiac output and mean arterial pressure (MAP) decrease during recruitment ( P 0.05) ,but there was nosignificant