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目的:研究肺复张手法((Recruitment Maneuver,RM))治疗急性呼吸窘迫综合征(ARDS)的同时对腹腔脏器血流灌注有何影响。方法:西宁地区(海拔2260m)急性呼吸窘迫综合征患者53例(APACHEⅡ评分17.7±7.8),在确诊ARDS1小时内置入胃张力计导管,并开始机械通气治疗,应用RM。分别在开始机械通气即刻(T1),RM开始前(T2),RM结束后30min(T3),RM结束后60min(T4)监测患者胃黏膜pH值(pHi)和动脉血氧分压(PaO2),计算氧合指数(PaO2/FiO2)。结果:53例患者中5例死亡,其中3例并发多脏器功能衰竭,1例并发脑疝,1例并发急性心肌梗塞。其余48例患者使用RM后PaO2、PaO2/FiO2较RM前显著升高(P<0.05);pHi在RM前后无显著变化(P>0.05)。结论:RM作为治疗ARDS的有效手段可显著升高PaO2,并不会造成胃肠黏膜等腹腔脏器组织的缺血缺氧。
Objective: To investigate the effect of Recruitment Maneuver (RM) on the perfusion of abdominal viscera while treating acute respiratory distress syndrome (ARDS). Methods: Fifty-three patients with acute respiratory distress syndrome (elevation of 2260m) in Xining (APACHEⅡscore 17.7 ± 7.8) were enrolled into the gas tension meter catheter within 1 hour of ARDS. Mechanical ventilation was started and RM was applied. Gastric mucosal pH (pHi) and arterial oxygen pressure (PaO2) were monitored at the beginning of mechanical ventilation (T1), before the start of RM (T2), after the end of RM 30min (T3), and after 60min (T4) , Calculate the oxygenation index (PaO2 / FiO2). Results: Five of the 53 patients died, of which 3 were complicated with multiple organ failure, 1 with hernia, and 1 with acute myocardial infarction. PaO2 and PaO2 / FiO2 in the remaining 48 cases were significantly higher than those before RM (P <0.05). No significant change was found in pHi before and after RM (P> 0.05). Conclusion: RM as an effective treatment of ARDS can significantly increase PaO2, will not cause gastrointestinal mucosa and other abdominal organs ischemia and hypoxia.