不同潮气量对急性呼吸窘迫综合征病人肺损伤的影响

金芳; 刘龙; 彭媛

doi:10.13898/j.cnki.issn.1000-2200.2020.06.013

不同潮气量对急性呼吸窘迫综合征病人肺损伤的影响

Effect of different tidal volume on lung injury in patients with acute respiratory distress syndrome

摘要

摘要:
目的探讨不同潮气量对急性呼吸窘迫综合征（ARDS）病人肺损伤的影响。
方法以呼吸系统顺应性（C）=0.6 mL·cmH₂O^-1·kg^-1为界将ARDS病人分为2组，其中C≥0.6 mL·cmH₂O^-1·kg^-1者9例，C < 0.6 mL·cmH₂O^-1·kg^-1者10例，分别记为C≥0.6组和C < 0.6组。测定不同潮气量6 mL/kg.IBW、8 mL/kg.IBW、10 mL/kg.IBW、12 mL/kg.IBW）下的呼气末肺容积（EELV），计算肺应变，观察不同潮气量下气道峰压（Ppeak）、气道平台压（Pplat）等的变化。
结果纳入行机械通气的ARDS病人19例，C≥0.6组9例，C < 0.6组10例。随着潮气量的增加，Ppeak和Pplat均逐渐增加，且Pplat均≤30cmH₂O。与6 mL/kg.IBW潮气量相比，8 mL/kg.IBW、10 mL/kg.IBW和12 mL/kg.IBW潮气量的Pplat差异均有统计学意义（P < 0.05）。在所有病人中，潮气量由6 mL/kg.IBW逐渐增加至12 mL/kg.IBW时，肺应变由（0.31±0.27）逐渐增加至（0.52±0.46），且潮气量和肺应变呈显著正相关关系（r=0.978，P < 0.01）。对于C≥0.6组的病人，与6 mL/kg.IBW潮气量相比，仅12 mL/kg.IBW潮气量的肺应变明显增加，差异有统计学意义（P < 0.05），且10 mL/kg.IBW、12 mL/kg.IBW潮气量通气时肺应变>0.27。C < 0.6组的病人中，与6 mL/kg.IBW潮气量相比，8 mL/kg.IBW、10 mL/kg.IBW和12 mL/kg.IBW潮气量的肺应变差异无统计学意义（P>0.05），且不同潮气量时肺应变均>0.27。
结论C≥0.6 mL·cmH₂O^-1·kg^-1的ARDS病人，在机械通气时潮气量适当增加至8 mL/kg.IBW并不明显加重肺损伤；而C < 0.6 mL·cmH₂O^-1·kg^-1的病人即使采用6 mL/kg.IBW潮气量通气仍可致严重肺损伤。

Abstract:
ObjectiveTo investigate the effects of different tidal volume on lung injury in patients with acute respiratory distress syndrome(ARDS).
MethodsThe respiratory system compliance(C)=0.6 mL·cmH₂O^-1·kg^-1 was set as the critic point, the patients were divided into the C≥0.6 group9 cases with (C)≥0.6 mL·cmH₂O^-1·kg^-1 and C < 0.6 group(10 cases with C < 0.6 mL·cmH₂O^-1·kg^-1).At different tidal volume (6 mL/kg.IBW, 8 mL/kg.IBW, 10 mL/kg.IBW, 12 mL/kg.IBW), the end-expiratory lung volume(EELV) was detected, the pulmonary strain was calculated, and the changes of peak pressure(Ppeak) and plateau pressure(Pplat) were observed.
ResultsWith the increasing of tidal volume, the Ppeak and Pplat increased, and the Pplat was ≤30 cmH₂O.The differences of the Pplat between the tidal volume of 6 mL/kg.IBW and 8 mL/kg.IBW, 10 mL/kg.IBW, 12 mL/kg.IBW were statistically significant(P < 0.05).When the tidal volume increased gradually from 6 mL/kg.IBW to 12 mL/kg.IBW, the the pulmonary strain increased from (0.31±0.27) to (0.52±0.46), and the tidal volume was positively correlated with pulmonary strain(r=0.978, P < 0.01).Compared with 6 mL/kg.IBW, the pulmonary strain in C≥0.6 group significantly increased under 12 mL/kg.IBW tidal volume ventilation, and the difference of which was statistically significant(P < 0.05).Under 10 mL/kg.IBW and 12 mL/kg.IBW tidal volume ventilation, the pulmonary strain was more than 0.27.Compared with VT=6 mL/kg.IBW, the differences of the pulmonary strain in C < 0.6 group among 8 mL/kg·IBW, 10 mL/kg·IBW and 12 mL/kg.IBW tidal volume ventilation were not statistically significant(P>0.05), and the pulmonary strain under different tidal volumes was more than 0.27.
ConclusionsFor the ARDS patients with C≥0.6mL·cmH₂O^-1·kg^-1, the tidal volume increasing to 8 mL/kg.IBW does not aggravate lung injury.For the ARDS patients with C < 0.6mL·cmH₂O^-1·kg^-1, the ventilation with 6 mL/kg.IBW tidal volume can still aggravate lung injury.

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