论文部分内容阅读
目的 ARDS肺复张确定最佳PEEP,是临床工作中ARDS肺保护性通气的难点。我们通过对比最大氧合法与监测肺动态顺应性法联合潮气二氧化碳排除确定的最佳PEEP对ARDS家兔的复张影响,比较这两种选择最佳PEEP方法之间的优劣。方法气管内灌洗生理盐水建立ARDS家兔模型,PCV法肺复张后治疗组以动态顺应性联合潮气二氧化碳排除PEEP滴定法确定最佳PEEP,对照组采用最大氧合法确定最佳PEEP,监测呼吸力学及血流动力学指标。结果两组家兔肺复张后及复张后期滴定的PEEP治疗组明显低于对照组,差异有显著性(P<0.05);治疗组较对照组肺顺应性明显改善(P<0.05);治疗组肺复张后期PaCO2明显降低(P<0.05);对照组复张前后MAP及CVP变化明显(P<0.05),治疗组无明显变化;两组间肺复张后氧合指数无明显差异,肺湿重干重比(W/D)无明显差异。结论肺复张能够改善ARDS家兔的氧合水平,监测Cdyn联合VTCO2较最大氧合法获得PEEP值低,肺顺应性改善明显,对血流动力学影响小。
Objective To determine the optimal PEEP for pulmonary recanalization of ARDS is a difficult point of ARDS lung protection ventilation in clinical work. We compare the pros and cons of the two best PEEP methods by comparing the effects of maximal oxygenation and monitoring of pulmonary dynamic compliance on optimal AREP rabbits with ARDS determined by combination of tidal carbon dioxide exclusion. Methods ARDS rabbit model was established by lavage of saline into the trachea. After PEV in PCV group, PEEP titration was used to determine the best PEEP in the treatment group and the best PEEP was detected in the control group by maximum oxygenation. Mechanics and hemodynamics. Results The PEEP in the two groups were significantly lower than those in the control group (P <0.05). The lung compliance of the treatment group was significantly improved than that of the control group (P <0.05). The PaCO2 in the treatment group was significantly lower (P <0.05) than that in the control group (P <0.05), while the changes of MAP and CVP in the control group before and after reexpansion were significantly (P <0.05), and there was no significant change in the treatment group. There was no significant difference in oxygenation index , Lung wet weight to dry weight ratio (W / D) no significant difference. Conclusions Pulmonary reexpansion can improve the oxygenation level in ARDS rabbits. The monitoring of Cdyn combined with VTCO2 shows that the PEEP value is lower than that of maximal oxygenation, the pulmonary compliance is obviously improved, and the hemodynamics is little affected.