床旁超声导向的最佳PEEP对ARDS患者氧合及血流动力学的影响

摘要

目的：探讨床旁超声导向的最佳呼气末正压（PEEP）对急性呼吸窘迫综合征（ARDS）患者氧合及血流动力学的影响。方法将 ICU 病房中22例 ARDS 患者根据肺复张（RM）后 PEEP 设置方法的不同分为分为床旁超声组（A组）和最大氧合法组（B 组），各11例。对两组持续监测心电图并记录血流动力学指标[平均动脉血压（ MAP），心率（HR），中心静脉压（CVP）]；行血气分析测定 pH、动脉血氧分压（PaO2）和吸入氧气分压（FiO2），并计算氧合指数（PaO2/FiO2）；通过呼吸机监测并记录呼气末正压（PEEP）、潮气量（VT）和气道峰压（Ppeak）并计算动态顺应性（Cdyn）。比较两组 RM 前，RM 后15 min、1 h、2 h 时的 PaO2/ FiO2、Cdyn 和血流动力学指标。结果两组 Cdyn 和 PaO2/ FiO2在 RM 后15 min、1 h 和2 h 均高于 RM 前（ P 0.05）；两组在 RM 后15 min CVP、HR 高于 RM 前，MAP 低于 RM 前（ P 0.05）；A 组 CVP 在 RM后1 h 高于 RM 前（ P 0.05）；A 组 CVP 在 RM后15 min 高于 B 组（ P 0.05）。结论 RM 后床旁超声设置的最佳 PEEP 值可以更明显改善氧合和呼吸系统顺应性，对血流动力学无严重的不良影响。%Objective To explore The effects of the best PEEP by bedside ultrasound on oxygenation and hemodynamics in ARDS pa-tients. Methods According to the lung recruitment(RM)after PEEP setting methods,22 patients with ARDS were randomly divided into bed-side ultrasound group(A group)and oxygenation group(B group)with 11 cases in each group. Continuous monitoring of ECG and hemodynamic parameters(MAP,HR,CVP)were recorded. Arterial blood gas analysis was performed to determine pH,arterial partial pressure of oxygen (PaO2 )and oxygen fraction of FiO2 ,and calculated the oxygenation index(PaO2 / FiO2 ). Through the ventilator monitoring,end expiratory posi-tive pressure(PEEP),tidal volume(VT)and peak airway pressure( ppeak)and calculation of dynamic compliance( cdyn)were recorded. PaO2 / FiO2 ,Cdyn and hemodynamic parameters at before RM and after RM(at 15 min,1 h and 2 h)were compared in the two groups. Results The PaO2 / FiO2 and Cdyn after RM 15 min,1 h and 2 h were higher than before RM in two groups( P 0. 05). The HR and CVP were higher than before RM,MAP was higher than before RM in two groups( P > 0. 05). The HR and MAP CVP were no significance after RM 1h and 2h in two groups( P > 0. 05). The CVP after RM 15min was higher than before RM in A group( P 0. 05). The A group CVP after RM 15min was higher than B groups( P 0. 05). Conclusion The best PEEP by bedside ultrasound improves oxygenation and compiiance of the respiratory system and has no obvious adverse effect on hemodynamics.