肺复张和保护性通气治疗术后急性呼吸窘迫综合征的效果观察

doi:10.19739/j.cnki.issn1001-9510.2019.05.002

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Abstract Objective To investigate the clinical effect of early lung recruitment maneuver combined with protective mechanical ventilation on patients with acute respiratory distress syndrome (ARDS) after operation. Methods A prospective randomized controlled study was designed to select the patients with severe ARDS in early stage. The patients with early severe ARDS were divided into the standard treatment group and the lung recruitment therapy group. The patients were transferred to ICU, and given the treatment of primary disease, protective ventilation strategy and airway humidification therapy. The standard treatment group was treated with protective mechanical ventilation (PCV), the tidal volume (VT) was less than 6 mL/kg, the inhalation oxygen concentration (FiO₂) and the positive end expiratory pressure (PEEP) were adjusted, and the airway plateau pressure (Pplat) was less than 30 cmH₂O. The lung recruitment therapy group was combined with intermittent lung recruitment on the basis of protective mechanical ventilation, the lungs were recruited once every 6 hours until 24 hours after recruitment or the ventilator was withdrawn. The changes of respiratory and hemodynamic indexes were compared between the two groups before and after treatment, and the prognosis and complications were recorded. Results 67 patients were included in the analysis, including 35 in the standard treatment group and 32 in the lung recruitment therapy group. After being randomized into the group, compared with the standard treatment group, PaO₂/FiO₂ of the lung recruitment therapy group increased after 0.5 h of treatment, and the respiratory system compliance showed an improvement trend, but there was no statistical difference. The levels of FiO₂ and PEEP in the two groups were significantly different. After 6.5 h, PaO₂/FiO₂ of the lung recruitment therapy group was significantly increased, respiratory compliance was improved, and FiO₂ was significantly decreased.Compared with the standard treatment group, ICU hospitalization time, mechanical ventilation time and artificial airway extraction timeof the lung recruitment therapy group were significantly shortened. Conclusion Compared with the standard treatment, lung recruitment combined with protective ventilation given to the patients with moderate to severe ARDS can improve the lung compliance and correct hypoxemia, shortening the mechanical ventilation time and the time of hospitalization of ICU, promoting the recovery of the patients.

Key words： mechanical ventilation lung recruitment maneuver postoperative complications acute respiratory distress syndrome perioperative period

Received: 22 March 2019

PACS:

R473.6

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	Articles by authors
	KONG Lingchen
	SUN Yunbo
	XU Jianhua
	PENG Wenhong
	LU Shijun
	NING Chao
	LI Haiyan

Cite this article:

KONG Lingchen,SUN Yunbo,XU Jianhua, et al. Effect of lung recruitment maneuver and protective ventilation on postoperative acute respiratory distress syndrome[J]. 滨州医学院学报, 2019, 42(5): 323-327.

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http://manu58.magtech.com.cn/Jwk_bzyxy/EN/10.19739/j.cnki.issn1001-9510.2019.05.002 OR http://manu58.magtech.com.cn/Jwk_bzyxy/EN/Y2019/V42/I5/323

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