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目的:观察叹气法肺复张治疗肺内源性和外源性急性呼吸窘迫综合征(ARDS)的效果及对血流动力学的影响。方法:选择ARDS 60例,根据病因分为外源性ARDS组27例和内源性ARDS组33例。两组均采用叹气法进行肺复张治疗,比较两组基础期、叹气期第30min、60min的血流动力学、血气分析、呼吸力学指标差异。结果:两组平均动脉压(MAP)、心率(HR)治疗前后组内或组间差异均不显著(P>0.05),叹气期30min CI均较同组基础期显著下降(P<0.05),但两组之间不同时间节点均差异不显著(P>0.05)。两组叹气期30min、60min PaO2/FiO2均较同组基础期显著升高(P<0.05),外源性ARDS组PaO2/FiO2显著高于同时间节点内源性ARDS组(P<0.05)。外源性ARDS组呼吸系统静态顺应性(CS)在叹气期较基础期显著升高,且显著高于内源性ARDS组(P<0.05)。结论:叹气法肺复张对不同分型ARDS的血流动力学影响相似,但外源性ARDS肺顺应性及氧合状态改善效果优于内源性ARDS。
OBJECTIVE: To observe the effect of sigh method of pulmonary remodeling on endogenous and exogenous acute respiratory distress syndrome (ARDS) and its effect on hemodynamics. Methods: Sixty ARDS patients were selected. According to the etiology, they were divided into exogenous ARDS group (n = 27) and endogenous ARDS group (n = 33). Two groups were sigh method of pulmonary reperfusion treatment, the two groups were compared at baseline, sigh 30min, 60min hemodynamics, blood gas analysis, respiratory mechanics differences. Results: There was no significant difference between the two groups in mean arterial pressure (MAP) and heart rate (HR) before and after treatment (P> 0.05), but the 30 min CI in sighing stage was significantly lower than that in the same group (P <0.05) However, there was no significant difference between the two groups at different time points (P> 0.05). PaO2 / FiO2 in both groups increased significantly at 30 min and 60 min (P <0.05), while PaO2 / FiO2 in exogenous ARDS group was significantly higher than that of endogenous ARDS group at the same time point (P <0.05). Respiratory system static compliance (CS) in exogenous ARDS group was significantly higher than that in basal stage at sighing stage and significantly higher than that in endogenous ARDS group (P <0.05). CONCLUSIONS: The effects of sigh regressions on the hemodynamics of ARDS with different subtypes are similar, however, the lung compliance and oxygenation status of ARDS are better than that of endogenous ARDS.