肺复张治疗体外循环心脏术后早期ALI-ARDS的临床研究

摘要

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(P<0.05).There were no significant differences in hemodynamics before and after pulmonary rehabilitation(P>0.05).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.%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（P<0.05）；肺复张前后血流动力学指标比较，差异均无统计学意义（P>0.05）。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。