摘要
目的探讨跨肺压指导呼气末正压通气(PEEP)选择对急性主动脉夹层术后低氧血症患者氧合、血流动力学及预后的影响。方法采用前瞻性随机对照研究,入选2014年1月—2015年8月急性Stanford A型主动脉夹层术后低氧血症患者28例,随机分为2组:个体化治疗组(n=19),肺复张后通过食道压监测结果调整PEEP;传统机械通气治疗组(n=9),肺复张后按照ARDSnet建议调整PEEP。比较2组患者呼吸、血流动力学参数、机械通气时间、住ICU时间及住院病死率。结果第72 h,个体化治疗组的PEEP、吸气末跨肺压均较传统机械通气治疗组高(P<0.05);第72 h,个体化治疗组动脉血氧分压(PO2)、氧合指数高于传统机械通气治疗组(P<0.05)。整个实验过程中,2组患者的心率和心排量无明显差异(P>0.05)。个体化治疗组患者机械通气时间和住ICU时间均比传统机械通气组时间短(P<0.05),2组患者的住院病死率无统计学差异(P>0.05)。结论肺复张后应用跨肺压指导PEEP的机械通气策略可改善急性主动脉夹层术后低氧血症患者氧合,缩短机械通气时间、住ICU时间,且不会引起循环波动。
Objective To explore the influence of transpulmonary gradient titration positive end expiratory pressure （PEEP） selection on oxygenation, hemodynamies and prognosis of patients with hypoxemia after acute aortic dissection surgery. Methods A perspective, randomized and con- trolled study was conducted, in which 28 patients with hypoxemia after acute type Stanford A aortic dissection surgery in our hospital from January 2014 to August 2015 were enrolled and randomly divid- ed into two groups. Individual treatment group （n = 19） received regulation of PEEP by esophageal pressure monitoring results after pulmonary re-expansion, while conventional mechanical ventilation treatment group （ n = 9） was given regulation of PEEP according to ARDSnet advice after pulmonary re-expansion. Respiration, hemodynamic parameters, mechanical ventilation duration, intensive care unit （ICU） stays and hospital mortality rate were compared between two groups. Results At 72 h after treatment, individual treatment group was markedly higher than conventional mechanical ventilation treatment group in PEEP and end-inspiratory transpulmonary gradient （P 〈 0.05 ）, and was notably higher in arterial partial pressure of oxygen （ PO2 ） and oxygenation indexes （P 〈 0.05 ）. During the whole experiment , there was no significant difference between two groups in heart rate and cardiac output （P 〉 0.05）. Meanwhile, individual treatment group was evidently shorter than control group in mechanical ventilation duration and ICU stay （P 〈 0.05 ）. However, there was no significant difference between two groups in hospital mortality rate （P 〉 0.05 ）. Conclusion Application of mechanical ventilation using transpulmonary gradient-guided PEEP after pulmonary re-expansion can effectively improve the oxygenation and shorten the mechanical ventilation and ICU stay without triggering circular fluctuation in patients with hypoxemia after acute aortic dissection surgery.
出处
《实用临床医药杂志》
CAS
2016年第24期1-6,共6页
Journal of Clinical Medicine in Practice
基金
江苏省南京市医学重点科技发展项目(ZKX14036)
关键词
急性主动脉夹层
低氧血症
跨肺压
食道压
acute aortic dissection
hypoxemia
transpulmonary gradient
esophageal pressure
