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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2022年06期

页码:

796-800

栏目:

论著

出版日期:

2022-12-20

文章信息/Info

Title:

Effect of bronchopulmonary segments recruitment on the survival of patients with severe acute respiratory distress syndrome

作者:

胡宗俊; 岳希; 黄霞

404000 重庆,重庆大学附属三峡医院重症医学科

Author(s):

Hu Zongjun;  Yue Xi;  Huang Xia.

Department of critical care medicine, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, 404000, China

关键词:

肺段肺复张;  急性呼吸窘迫综合征;  球囊导管

Keywords:

Bronchopulmonary segments recruitment;  Acute respiratory distress syndrome;  Balloon catheter

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2022.06.006

摘要:

目的 分析肺段肺复张对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者预后的影响。方法 选择2020年4月至2022年4月我院收治的重症ARDS患者30例,随机分为观察组17例,对照组13例,对照组采取肺保护性通气策略联合俯卧位通气,观察组在此基础上给予肺段肺复张。比较两组患者呼吸参数、动脉血气、血流动力学、并发症及预后。结果 治疗72 h后,观察组呼吸末正压、平台压低于对照组,静态肺顺应性高于对照组(P<0.05); 观察组pH和氧合指数高于对照组,二氧化碳分压低于对照组(P<0.05); 观察组进行肺段肺复张前后平均动脉压、心率变化无统计学差异(P>0.05); 观察组每搏输出量指数高于对照组,血管外肺水指数和肺血管通透性指数低于对照组(P<0.05); 观察组与对照组气胸及纵膈气肿发生率差异无统计学意义(P>0.05),住院期间病死率观察组较对照组下降(P<0.05)。结论 肺段肺复张能改善重症ARDS患者呼吸功能,对血流动力学影响较小,不增加气胸及纵膈气肿等并发症,可改善患者预后。

Abstract:

Objective To evaluate the effects of bronchopulmonary segments recruitment on clinical outcomes in patients with severe acute respiratory distress syndrome. Methods From April 2020 to April 2022, 30 patients with severe ARDS in our hospital were randomly divided into an observation group 17 cases and a control group 13 cases. All patients were given lung protective ventilation strategies and prone position, and the observation group was additionally given bronchopulmonary segments recruitment. The respiratory parameters, arterial blood gas, hemodynamic, complications and outcomes were compared between the two groups. Results After 72 hours of treatment, static compliance of the respiratory system, pH, the oxygenation index, stroke volume index in the observation group were higher than those of the control group(P<0.05). whereas positive end-expiratory pressure, partial pressure of carbon dioxide, the plateau pressure, extravascular lung water index, pulmonary vascular permeability index and mortality during hospital were lower than those of control group(P<0.05). No significant difference between the two groups were shown in the mean arterial pressure, heart rate, complications. Conclusions In patients with severe ARDS, based on lung protective ventilation strategy and prone ventilation, application of bronchopulmonary segments recruitment can improve the respiratory function, has little effect on hemodynamics, does not increase the complications such as pneumothorax and mediastinum emphysema. Therefore, bronchopulmonary segments recruitment can significantly improve the clinical outcomes of severe ARDS patients.

参考文献/References:

1 薄丽艳, 李聪聪, 金发光. 抗氧化治疗在急性肺损伤和急性呼吸窘迫综合征中的应用进展[J/CD]. 中华肺部疾病杂志(电子版), 2016, 9(1): 80-81.
2 Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition[J]. JAMA, 2012, 307(23): 2526-2533.
3 Deans KJ, Minneci PC, Cui X, et al. Mechanical ventilation in ARDS: One size does not fit all[J]. Crit Care Med, 2005, 33(5): 1141-1143.
4 刘士琛, 王美菊, 刘 刚, 等. 肺炎合并低氧血症患者进展为ARDS危险因素分析[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(2): 164-168.
5 凡 华, 张国新, 李 庚. MicroRNA-155联合MicroRNA-127对急性呼吸窘迫综合征预后的意义[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(6): 760-763.
6 Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2010, 181(6): 578-586.
7 Iannuzzi M, De SA, De RE, et al. Different patterns of lung recruitment maneuvers in primary acute respiratory distress syndrome: Effects on oxygenation and central hemodynamics[J]. Minerva Anestesiol, 2010, 76(9): 692-698.
8 Schmidt M, Stewart C, Bailey M, et al. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study[J]. Crit Care Med, 2015, 43(3): 654-664.
9 Meade MO, Cook DJ, Guyatt GH, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome[J]. JAMA, 2008, 299(6): 637-645.
10 Fossali T, Pavlovsky B, Ottolina D, et al. Effects of prone position on lung recruitment and ventilation-perfusion matching in patients with COVID-19 acute respiratory distress syndrome: A combined CT scan/electrical impedance tomography study*[J]. Crit Care Med, 2022, 50(5): 723-732.
11 Cavalcanti AB, Suzumura É, Laranjeira LN, et al. Effect of lung recruitment and titrated positive end-expiratory pressure(PEEP)vs low PEEP on mortality in patients with acute respiratory distress syndrome: A randomized clinical trial[J]. Jama J Am Med Assoc, 2017, 318(14): 1335-1345.
12 Hodgson CL, Cooper DJ, Arabi Y, et al. Maximal recruitment open lung ventilation in acute respiratory distress syndrome(PHARLAP). A phase Ⅱ, multicenter randomized controlled clinical trial[J]. Am J Respir Crit Care Med, 2019, 200(11): 1363-1372.
13 Constantin JM, Jabaudon M, Lefrant JY, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France(the LIVE study): a multicentre, single-blind, randomised controlled trial[J]. Lancet Respir Med, 2019, 7(10): 870-880.
14 Gattinoni L, Marini JJ, Pesenti A, et al. The “baby lung” became an adult[J]. Intens Care Med, 2016, 42(5): 663-673.
15 Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome[J]. New England J Med, 2000, 342(18): 1301-1308.
16 Richard JC, Maggiore SM, Jonson B, et al. Influence of tidal volume on alveolar recruitment. Respective role of PEEP and a recruitment maneuver[J]. Am J Respir Crit Care Med, 2001,163(7): 1609-1613.
17 Lachmann B. Open up the lung and keep the lung open[J]. Intens Care Med, 1992,18(6): 319-321.
18 Di Marco F, Devaquet J, Lyazidi A, et al. Positive end-expiratory pressure-induced functional recruitment in patients with acute respiratory distress syndrome[J]. Crit Care Med, 2010, 38(1): 127-132.
19 Pensier J, de Jong A, Hajjej Z, et al. Effect of lung recruitment maneuver on oxygenation, physiological parameters and mortality in acute respiratory distress syndrome patients: a systematic review and meta-analysis[J]. Intens Care Med, 2019, 45(12): 1691-1702.
20 Puybasset L, Cluzel P, Gusman P, et al. Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group[J]. Intens Care Med, 2000, 26(7): 857-869.
21 Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome[J]. Lancet, 2021, 398(10300): 622-637.
22 Hodgson CL, Tuxen DV, Davies AR, et al. A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome[J]. Crit Care, 2011, 15(3): R133.
23 Bhattacharjee S, Soni KD, Maitra S. Recruitment maneuver does not provide any mortality benefit over lung protective strategy ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis and systematic review of the randomized controlled trials[J]. J Intens Care, 2018, 6(null): 35.
24 Boissier F, Katsahian S, Razazi K, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome[J]. Intens Care Med, 2013, 39(10): 1725-1733.
25 Ijland MM, Heunks LM, van der Hoeven JG. Bench-to-bedside review: hypercapnic acidosis in lung injury-from ‘permissive' to ‘therapeutic'[J]. Crit Care, 2010, 14(6): 237.
26 Mekontso Dessap A, Charron C, Devaquet J, et al. Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome[J]. Intens Care Med, 2009, 35(11): 1850-1858.
27 Schmitt JM, Vieillard-Baron A, Augarde R, et al. Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements[J]. Crit Care Med, 2001, 29(6): 1154-1158.
28 Scholten EL, Beitler JR, Prisk GK, et al. Treatment of ARDS with prone positioning[J]. Chest, 2017, 151(1): 215-224.
29 Fossali T, Pavlovsky B, Ottolina D, et al. Effects of prone position on lung recruitment and ventilation-perfusion matching in patients with COVID-19 acute respiratory distress syndrome: A combined CT scan/electrical impedance tomography study[J]. Crit Care Med, 2022, 50(5): 723-732.
30 Richter T, Bellani G, Scott Harris R, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury[J]. Am J Respir Crit Care Med, 2005, 172(4): 480-487.
31 Lim CM, Kim EK, Lee JS, et al. Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome[J]. Intens Care Med, 2001, 27(3): 477-485.
32 Rossi S, Palumbo MM, Sverzellati N, et al. Mechanisms of oxygenation responses to proning and recruitment in COVID-19 pneumonia[J]. Intens Care Med, 2022, 48(1): 56-66.

备注/Memo

备注/Memo:

项目基金: 重庆市科卫联合医学科研项目(2020FYYX167)
通信作者: 黄 霞, Email: effiezhx@126.com

常用功能

更新日期/Last Update: 2022-12-20