| 韩虎,袁军,李建国.呼气末正压和吸氧浓度调整顺序对急性呼吸窘迫综合征机械通气恢复期病人肺部损伤的影响[J].安徽医药,2023,27(5):941-944. |
| 呼气末正压和吸氧浓度调整顺序对急性呼吸窘迫综合征机械通气恢复期病人肺部损伤的影响 |
| The effects of adjusting sequence of PEEP and oxygen inhalation on lung injury in patients with ARDS in the recovery period of mechanical ventilation |
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| DOI：10.3969/j.issn.1009-6469.2023.05.020 |
| 中文关键词: 呼吸窘迫综合征，成人 炎症反应 吸氧浓度 肺损伤 机械通气 肺表面活性蛋白 A |
| 英文关键词: Respiratory distress syndrome, adult Inflammatory response Inspired oxygen concentration Lung injury Me-chanical ventilation Pulmonary surfactant protein A |
| 基金项目:河北省卫生和计划生育委员会资助项目( 20170034) |
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| 中文摘要: |
| 目的探究呼气末正压( PEEP)和吸氧浓度( FiO2)调整顺序对急性呼吸窘迫综合征( ARDS)机械通气恢复期病人肺部损伤的影响。方法选取 2016年 7月至 2020年 8月在河北省人民医院急诊重症监护室( EICU)就诊的 80例需机械通气的 AR-DS病人，采用随机数字表法分为 PEEP固定组和 FiO2固定组，各 40例。两组病人均采用肺保护性通气策略。病情稳定后， PEEP固定组维持呼吸机参数不变( PEEP=12~15 cmH2O)FiO2逐渐调整为 80%、60%、40%；FiO2固定组维持 FiO2=60%不变， PEEP水平逐渐调整为 12、10、8 cm H2O。对比不同时间肺泡，灌洗液( BALF)中肿瘤坏死因子( TNF-α)、白细胞介素 -6(IL-6)和肺表面活性蛋白 A(SP-A)水平。结果随着 PEEP水平和 FiO2的降低，两组病人 TNF-α、IL-6和 SP-A水平呈下降趋势；但调整参数 1h后， TNF-α、IL-6和 SP-A水平升高。两组病人在调整 FiO2=40%、PEEP=8 cm H2O前 0h，TNF-α、IL-6和 SP-A水平最低，且 FiO2固定组低于 PEEP固定组(P<0.05)。结论降低 PEEP水平和 FiO2有利于减轻 ARDS病人炎症反应及降低 SP-A水平，先降低 PEEP水平后降低 FiO2，对 ARDS机械通气恢复期病人肺部炎性损伤的改善作用较好。 |
| 英文摘要: |
| Objective To explore the effect of adjusting sequence of positive end expiratory pressure (PEEP) and inspired oxygen concentration (FiO2) on lung injury in patients with acute respiratory distress syndrome (ARDS) in the recovery period of mechanical ventilation.Methods Eighty ARDS patients in need of mechanical ventilation who were treated in the Emergency Intensive Care Unit(EICU) of Hebei Provincial People's Hospital from July 2016 to August 2020 were randomly assigned into PEEP fixation group andFiO2 fixation group, with 40 cases in each group. Both groups adopted lung protective ventilation strategies. After the condition was sta-ble, the PEEP fixation group maintained the same ventilator parameters (PEEP=12-15 cm H2O), and the FiO2 was gradually adjusted to 80%, 60%, 40%, while the FiO2 fixation group maintained FiO2 at 60% unchanged, and the PEEP level was gradually adjusted to 12, 10, 8 cm H2O. A comparison was made between the levels of tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and pulmonary surfac-tant protein A (SP-A) in bronchoalveolar lavage fluid (BALF) at different times.Results As the levels of PEEP and FiO2 decreased, the levels of TNF-α, IL-6 and SP-A in the two groups showed a downward trend; but 1 h after adjusting the parameters, the levels of TNF-α, IL-6 and SP-A increased. The patients in both groups had the lowest levels of TNF-α, IL-6 and SP-A 0 h before adjusting FiO2 to 40% and PEEP to 8 cm H2O, and they were lower in the FiO2 fixation group than the PEEP fixation group (P<0.05).Conclusions Reducing the levels of PEEP and FiO2 is beneficial to alleviating the inflammatory response and reducing SP-A level in patients with ARDS. Lowering the level of PEEP first and then reducing FiO2 has a better effect on improving the lung inflammatory injury in ARDS patients with in the recovery period of mechanical ventilation. |
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