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目的对比研究肺复张策略对肺内/外源性急性呼吸窘迫综合征治疗效果。方法18例急性呼吸窘迫综合征机械通气的患者,分肺内源性组和肺外源性组,其中肺内源性急性呼吸窘迫综合征10例,肺外源性急性呼吸窘迫8例。在肺保护性通气策略基础上行肺复张,在镇静、非肌松状态下,采用高水平持续正压通气,呼吸末正压为40 cm H2O,持续时间40 s。结果与肺复张前比较,两组复张后10 min3、0 min1、h2、h动脉血气分析氧饱和度、动脉氧分压均有提高(P<0.05),两组比较肺外源性组升高较为明显(P<0.05);复张前后两组二氧化碳分压均无明显变化(P>0.05),呼吸系统顺应性在复张后明显提高(P<0.05);气道峰压、平台压、中心静脉压、平均动脉压在复张过程中时提高(P<0.05),但复张后5 min与治疗前比较没有明显变化(P>0.05);复张前后心率没有明显变化(P>0.05)。结论肺复张措施对急性呼吸窘迫综合征患者能改善氧合、对血流动力学影响短暂、安全有效,对于肺外源性急性呼吸窘迫综合征治疗效果更明显。
Objective To compare the therapeutic effect of pulmonary tonic recovery strategy on pulmonary / exogenous acute respiratory distress syndrome. Methods Eighteen patients with acute respiratory distress syndrome who were ventilated mechanically were divided into two groups: pulmonary endogenous acute respiratory distress syndrome (10 cases) and extrinsic acute respiratory distress (8 cases). Lung resuscitation was performed on the basis of lung-protective ventilation strategy. In calm and non-muscle-relaxed state, a continuous positive pressure ventilation was used with a positive respiratory pressure of 40 cm H2O and a duration of 40 s. Results Compared with pre-reexpansion, oxygen saturation and arterial oxygen pressure of arterial blood gas in 3 groups were significantly increased at 10 min, 0 min, 1 h, 2 h after reperfusion (P <0.05) (P <0.05). The partial pressure of carbon dioxide did not change significantly in both groups before and after re-tensioning (P> 0.05), respiratory compliance increased significantly after resuscitation (P <0.05) Pressure, central venous pressure and mean arterial pressure increased during resuscitation (P <0.05), but there was no significant change at 5 min after resuscitation compared with those before treatment (P> 0.05). There was no significant change in heart rate before and after resuscitation (P > 0.05). Conclusions Lung recidivation measures can improve oxygenation in patients with acute respiratory distress syndrome, have a short-term effect on hemodynamics, are safe and effective, and are more effective in treating exogenous pulmonary acute respiratory distress syndrome.