呼气末正压通气对急性呼吸窘迫综合征患者氧利用率的疗效分析(1)
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[作者简介] 韩小彤(1967.4-)，女，湖南长沙人，副主任医师，主要从事急诊危重症救治及呼吸治疗工作。
[摘要] 目的：探讨呼气末正压通气对提高呼吸窘迫综合征(ARDS)患者氧气利用率(O2UC)的疗效。方法：选择我院2006年1月～2010年10月收治的呼吸窘迫综合征患者30例，均给予机械通气，分别调节PEEP为0、5、10、15 cm H2O压力水平，采集动静脉血，血气分析计算患者O2UC，同时监测心率(HR)、平均动脉压(MAP)等。结果：PEEP由0 cm H2O升高到15 cm H2O时患者PaO2、PaCO2、PaO2/FiO2不断升高(P<0.05)；PEEP由0 cm H2O升高到10 cm H2O时患者O2UC、MAP、HR均无明显变化，PEEP为15 cm H2O时，O2UC、MAP明显降低，HR较之前升高(P<0.05)。结论：ARDS患者PEEP治疗中，随着呼气末压力的增高，患者动脉氧分压也会升高，但是PEEP增高到一定水平时，患者氧利用率降低，因此治疗中要选择合适的PEEP水平，在提高PaO2的同时，保证氧利用率和心输出量。
[关键词] 急性呼吸窘迫综合征；呼气末正压通气；氧利用率；疗效分析
[中图分类号] R563.8 [文献标识码]A [文章编号]1673-7210(2011)07(c)-043-02
Clinical analysis of PEEP to oxygen utilization of ARDS
HAN Xiaotong, LIU Zhiling
Department of Emergency, the People's Hospital of Hu'nan Province, Hu'nan Province, Changsha 410005, China
[Abstract] Objective: To investigate the efficacy of PEEP to improve the oxygen utilization rate (O2UC) of acute respiratory distress syndrome (ARDS). Methods: 30 patients with ARDS in our hospital from January 2006 to October 2010 were treated with mechanical ventilation, PEEP pressure level were adjusted to 0, 5, 10, 15 cm H2O. Then collected the arterial and venous blood to calculate oxygen utilization, while monitored the heart rate (HR) and mean arterial pressure (MAP), and so on. Results: PaO2, PaCO2, PaO2/FiO2, had risen continuously when PEEP increased from 0 cm H2O to 15 cm H2O (P<0.05). O2UC,MAP,HR had no significant change when PEEP increased from 0 cm H2O to 10 cm H2O.When PEEP was 15 cm H2O, O2UC, MAP decreased significantly, while HR increased (P<0.05). Conclusion: In PEEP therapy course of ARDS patients, PaO2 is increasing as the PEFP pressure increasing. However, PEFP pressure has increased to a certain level, O2UC of patients become lower. Therefore, appropriate PEEP level should be selected to improve PaO2, and ensure oxygen utilization and cardiac output at the same time.
[Key words] Acute respiratory distress syndrome; Positive end espiratory pressure; Oxygen utilization; Efficacy analysis ......
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