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目的探讨肺复张策略结合保护性通气对急性呼吸窘迫综合征肺复张的疗效和安全性。方法16例急性呼吸窘迫综合征机械通气患者行肺复张,在镇静、非肌肉松弛状态下,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。结果与复张前比较,复张后动脉血气分析氧饱和度、动脉氧分压均有提高,10 min、30 min1、h、2 h提高有统计学意义(P<0.05);二氧化碳分压无明显变化(P>0.05);气道峰压、平台压在肺复张前后无明显变化(P>0.05),呼吸系统顺应性在复张后明显提高(P<0.05);中心静脉压、平均动脉压在复张过程中提高(P<0.05),但复张后5 min与治疗前比较没有明显变化(P>0.05),而心率也没有明显变化(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。
Objective To investigate the efficacy and safety of pulmonary recanalization combined with protective ventilation in the treatment of acute respiratory distress syndrome. Methods Sixteen patients with acute respiratory distress syndrome undergoing mechanical ventilation underwent pulmonary reexpansion. In calm and non-muscle relaxed state, high-level continuous positive pressure ventilation was used. The positive respiratory pressure was 40 cm H2O and the duration was 40 s. Results Compared with those before reexpansion, oxygen saturation and arterial oxygen pressure of arterial blood gas analysis increased after reperfusion, and increased significantly at 10 min, 30 min1, h and 2 h (P <0.05). The partial pressure of carbon dioxide (P> 0.05). The peak airway pressure and plateau pressure had no significant change before and after pulmonary reperfusion (P> 0.05), and respiratory compliance increased significantly after reexpansion (P <0.05). Central venous pressure, mean Arterial pressure increased during the course of resuscitation (P <0.05), but there was no significant change at 5 min after resuscitation compared with those before treatment (P> 0.05), while heart rate did not change significantly (P> 0.05). Conclusions Lung recanalization can improve oxygenation in patients with acute respiratory distress syndrome, and has a short-term effect on hemodynamics and is safe and effective.