中国医学创新目次肺复张治疗体外循环心脏术后早期ALI―ARDS临床探究.doc

中国医学创新目次肺复张治疗体外循环心脏术后早期ALI―ARDS临床探究 　　【摘要】 目的：探讨肺复张治疗体外循环心脏术后早期急性肺损伤-急性呼吸窘迫综合征（ALI-ARDS）的临床疗效。方法：采用肺复张治疗36例体外循环心脏术后行机械通气的患者，均符合ALI-ARDS诊断标准，比较肺复张前后氧合指数、血气分析及血流动力学变化。结果：36例患者肺复张后PaO2、氧合指数分别为（110.2±28.3）mm Hg、（164.0±52.2），明显高于肺复张前的（62.1±12.2）mm Hg、（102.8±38.2），差异均有统计学意义（P0.05）。肺复张过程中CVP出现短暂性增高。所有患者均无不良反应发生。结论：肺复张可以有效地改善体外循环心脏术后早期ALI-ARDS患者的氧合情况，同时对其血流动力学影响小 【关键词】 肺复张； 心脏手术； 体外循环； 急性肺损伤-急性呼吸窘迫综合征 【Abstract】 Objective：To investigate the therapeutic effect of pulmonary rehabilitation on acute lung injury and acute respiratory distress syndrome（ALI-ARDS） after cardiopulmonary bypass surgery.Method：A total of 36 cases of patients with mechanical ventilation after cardiopulmonary bypass were treated with pulmonary rehabilitation，they were in line with ALI-ARDS diagnostic criteria，the oxygenation index，blood gas analysis and hemodynamics changes before and after pulmonary rehabilitation were compared.Result：In 36 cases，PaO2 and oxygenation index after pulmonary rehabilitation were （110.2±28.3）mm Hg，（164.0±52.2），significantly higher than （62.1±12.2）mm Hg，（102.8±38.2）before the pulmonary rehabilitation，and the differences were statistically significant（P0.05）.In the process of recruitment maneuvers，CVP increased went up temporarily as the PEEP increased.But when the PEEP decreased，CVP would get normal.There were no adverse reactions in all of patients.Conclusion：Recruitment maneuvers is helpful to improve oxygenation for the patients suffering from ALI-ARDS after cardiac surgery with cardiopulmonary bypass，and impact little on the hemodynamics. 【Key words】 Recruitment maneuvers； Cardiac surgery； Cardiopulmonary bypass； Acute lung injury-acute respiratory distress syndrome First-authors address：Xiamen City Cardiovascular Hospital，Xiamen 361004，China doi：10.3969/j.issn.1674-4985.2016.32.013 ?w外循环心脏术属于一种常见的心外科手术，术后极易出现低氧血症[1]，因此部分患者需行机械通气治疗。作为常见的有效保护肺组织的通气手段，肺复张可迅速改善患者氧合，有利于尽早撤除呼吸机，减少呼吸机相关性肺炎发生，促进患者康复[2]。本科ICU采用肺复张治疗体外循环心脏术后早期急性肺损伤-急性呼吸窘迫综合征（acute lung injury-acu