肺复张对肺内外源性ARDS患者氧代谢及血流动力学的影响
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摘要
目的研究肺复张(RM)对肺内外源性ARDS患者氧代谢及血流动力学的影响。方法选取30例中度ARDS患者,分为肺内源性ARDS(ARDSp)组、肺外源性ARDS (ARDSexp)组,每组15例。均行肺保护通气策略(LPVS)及脉搏指示连续心输出量(PICCO)监测。观察RM前后氧代谢及血流动力学指标的变化。结果两组在RM后动脉血氧分压(PaO_2)、静脉血氧分压(PvO_2)、中心静脉血氧饱和度(ScvO_2)和氧输送(DO_2)明显升高(P <0. 05),氧摄取率(ERO_2)明显降低(P <0. 05); ARDSexp组的PaO_2、PvO_2、ScvO_2和DO_2高于ARDSp组(P <0. 05),ERO_2低于ARDSp组(P <0. 05)。两组心率(HR)无变化; RM时中心静脉压(CVP)明显升高,两组无明显差异(P> 0. 05),RM后很快恢复至基础值; RM时平均动脉压(MAP)和心脏指数(CI)明显下降(P <0. 05),RM后很快恢复至基础值,ARDSp组下降更显著(P <0. 05)。结论 RM能有效改善ARDS特别是ARDSexp患者氧代谢,对ARDS尤其ARDSp患者实施RM时需警惕血流动力学变化。
Objective To determine the effect of recruitment maneuver( RM) on oxygen metabolism and hemodynamics in patients with pulmonary and extra-pulmonary acute respiratory distress syndrome( ARDS). Methods 30 moderate ARDS patients were divided into the pulmonary ARDS group( ARDSp) and the extra-pulmonary ARDS group( ARDSexp) with 15 cases in each group. All patients were ventilated with lung protective ventilation strategy( LPVS) and monitored by pulse-induced contourcardiac output( Pi CCO). The indexes of oxygen metabolism and hemodynamics were measured before and after RM. Results After RM,arterial partial pressure of oxygen( PaO_2),venous partial pressure of oxygen( PvO_2),central venous oxygen saturation( ScvO_2) and oxygen delivery( DO_2) obviously increased( P < 0. 05),and oxygen extraction ratio( ERO_2) obviously decreased in both groups( P< 0. 05). The levels of PaO_2,PvO_2,ScvO_2 and DO_2 in the ARDSexp group were significantly higher than those in the ARDSp group( P < 0. 05),and the level of ERO_2 in the ARDSexp group were significantly lower than that in the ARDSp group( P < 0. 05). There was no significant difference in heart rate( HR) between baselines and RM period between the two groups. Although central venous pressure( CVP) significantly increased,mean arterial pressure( MAP) and cardiac index( CI) decreased obviously in both groups during RM( P < 0. 05),and they reversed rapidly after RM. During RM,CVP was significantly higher,and MAP and CI were significantly lower in the ARDSp group than in the ARDSexp group( P < 0. 05). Conclusion RM can effectively improve oxygen metabolism in patients with ARDS,especially ARDSexp. It is necessary to be vigilant against hemodynamic changes in patients with ARDS,especially ARDSp.
Objective To determine the effect of recruitment maneuver( RM) on oxygen metabolism and hemodynamics in patients with pulmonary and extra-pulmonary acute respiratory distress syndrome( ARDS). Methods 30 moderate ARDS patients were divided into the pulmonary ARDS group( ARDSp) and the extra-pulmonary ARDS group( ARDSexp) with 15 cases in each group. All patients were ventilated with lung protective ventilation strategy( LPVS) and monitored by pulse-induced contourcardiac output( Pi CCO). The indexes of oxygen metabolism and hemodynamics were measured before and after RM. Results After RM,arterial partial pressure of oxygen( PaO_2),venous partial pressure of oxygen( PvO_2),central venous oxygen saturation( ScvO_2) and oxygen delivery( DO_2) obviously increased( P < 0. 05),and oxygen extraction ratio( ERO_2) obviously decreased in both groups( P< 0. 05). The levels of PaO_2,PvO_2,ScvO_2 and DO_2 in the ARDSexp group were significantly higher than those in the ARDSp group( P < 0. 05),and the level of ERO_2 in the ARDSexp group were significantly lower than that in the ARDSp group( P < 0. 05). There was no significant difference in heart rate( HR) between baselines and RM period between the two groups. Although central venous pressure( CVP) significantly increased,mean arterial pressure( MAP) and cardiac index( CI) decreased obviously in both groups during RM( P < 0. 05),and they reversed rapidly after RM. During RM,CVP was significantly higher,and MAP and CI were significantly lower in the ARDSp group than in the ARDSexp group( P < 0. 05). Conclusion RM can effectively improve oxygen metabolism in patients with ARDS,especially ARDSexp. It is necessary to be vigilant against hemodynamic changes in patients with ARDS,especially ARDSp.
引文
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[6] KANOORE EDUL V S,MASKIN L P,DUBIN A. Efects of recruitment manoeuvres on haemodynamics,oxygen exchange and oxygen delivery in patients with acute lung injury and acute respiratory distress syndrome[J]. Crit Care Resusc,2010,12(3):143-148.
[7] TOTH I,LEINER T,MIKOR A,et al. Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome[J]. Crit Care Med,2007,35(3):787-793.
[8] PARK K J,OH Y J,CHANG H J,et al. Acute hemodynamic effects of recruitment maneuvers in patients with acute respiratory distress syndrome[J]. J Intensive Care Med,2009,24(6):376-382.
[9] SEHGAL I S,DHOORIA S,BEHERA D,et al. Acute respiratory distress syndrome:pulmonary and extrapulmonary not so similar[J]. Indian J Crit Care Med,2016,20(3):194-197.
[2] GATTINONI L,PELOSI P,SUTER P M,et al. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes?[J]. Am J Respir Crit Care Med,1998,158(1):3-11.
[3] AGARWAL R,SRINIVAS R,NATH A,et al. Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A meta analysis[J]. Chest,2008,133(6):1463-1473.
[4] RANIERI V M,RUBENFELD G D,THOMPSON B T,et al. Acute respiratory distress syndrome:the Berlin Definition[S]. JAMA,2012,307(23):2526-2533.
[5] CHIUMELLO D,BROCHARD L,MARINI J J,et al. Respiratory support in patients with acute respiratory distress syndrome:an expert opinion[J]. Crit Care,2017,21(1):240.
[6] KANOORE EDUL V S,MASKIN L P,DUBIN A. Efects of recruitment manoeuvres on haemodynamics,oxygen exchange and oxygen delivery in patients with acute lung injury and acute respiratory distress syndrome[J]. Crit Care Resusc,2010,12(3):143-148.
[7] TOTH I,LEINER T,MIKOR A,et al. Hemodynamic and respiratory changes during lung recruitment and descending optimal positive end-expiratory pressure titration in patients with acute respiratory distress syndrome[J]. Crit Care Med,2007,35(3):787-793.
[8] PARK K J,OH Y J,CHANG H J,et al. Acute hemodynamic effects of recruitment maneuvers in patients with acute respiratory distress syndrome[J]. J Intensive Care Med,2009,24(6):376-382.
[9] SEHGAL I S,DHOORIA S,BEHERA D,et al. Acute respiratory distress syndrome:pulmonary and extrapulmonary not so similar[J]. Indian J Crit Care Med,2016,20(3):194-197.