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目的探讨肺复张术对机械通气患者血压、血氧饱和度(SaO2)的影响及临床效果。方法选择2008年2月至2009年8月38例实施肺复张术患者,分析其复张效果、肺复张术的不良反应等。肺复张采取固定驱动压、逐渐增加呼气末正压(PEEP)的方法,所有肺复张患者均进行有创动脉血压监测。结果 38例患者进行了162次肺复张术,其中2例慢性阻塞性肺病急性加重(AECOPD)患者发生气胸,肺复张总有效率90%。肺复张中有效PEEP变化较大,最低6 cm H2O(1 cm H2O=0.098 kPa),最高30 cm H2O;SaO2维持最短0.5 h,最长126 h;平均每例患者接受4.26次,其中有1例患者最多接受8次肺复张术。18例(47%)患者在肺复张中曾经发生过低氧血症,162次肺复张术中发生72次(44%)低氧血症;开始诱发低氧血症的最低PEEP为6 cm H2O,最高为20 cm H2O,平均13.0 cm H2O。21例(55%)患者肺复张中曾发生过血压短暂降低,162次肺复张中有68次(41%)血压短暂降低;开始出现血压下降的最低PEEP为6 cm H2O,最高为21cm H2O,平均13.5 cm H2O。结论肺复张术可以有效改善SaO2,PEEP的设定应遵循个体化的原则。
Objective To investigate the effect and clinical effect of pulmonary atelectasis on blood pressure and oxygen saturation (SaO2) in patients with mechanical ventilation. Methods From February 2008 to August 2009, 38 patients undergoing pulmonary reexpansion were enrolled in this study. The effects of reexpansion and adverse reactions of pulmonary reexpansion were analyzed. Pulmonary recanalization A fixed driving pressure was used to gradually increase the positive end-expiratory pressure (PEEP), and all patients with pulmonary re-entry were monitored for invasive arterial pressure. Results A total of 162 pulmonary reexplosions were performed in 38 patients. Two of the two patients experienced pneumothorax and pulmonary reocclusion in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The total effective rate was 90%. The effective PEEP changes in pulmonary remodeling larger, the lowest 6 cm H2O (1 cm H2O = 0.098 kPa), up to 30 cm H2O; SaO2 maintained the shortest 0.5 h, the longest 126 h; average each patient received 4.26 times, of which 1 The patient receives up to 8 pulmonary remissions. Hypoxemia occurred in 18 patients (47%) during lung recruitment, 72 (44%) episodes of hypoxemia in 162 lung recovers, and the lowest PEEP to initiate hypoxemia was 6 cm H2O , Up to 20 cm H2O with an average of 13.0 cm H2O. A transient decrease in blood pressure occurred in 21 patients (55%) with a brief decrease in blood pressure 68 (41%) of 162 pulmonary remissions; a minimum PEEP of 6 cm H2O with a maximum blood pressure of 21 cm H2O, Average 13.5 cm H2O. Conclusions Pulmonary reexpansion can effectively improve SaO2. The setting of PEEP should follow the principle of individualization.