无创正压通气对脓毒症所致急性肺损伤患者血流动力学的影响

Effects of noninvasive positive ventilation on hemodynamics in patients with acute lung injury induced by sepsis

关键词:  脓毒症  无创正压通气  血流动力学

Key words:  sepsis  noninvasive positive ventilation  hemodynamics

摘要:

目的研究无创正压通气(noninvasive positive ventilation,NIPPV)对脓毒症所致急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)早期患者血流动力学的影响。方法收集脓毒症所致ALI/ARDS共27例,观察通气前,通气后2~4 h、24 h及撤机后的动脉血氧饱和度(SaO₂)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、心率(HR),以及无创心功能所测平均动脉压(MAP)、心脏指数(CI)、心排血量(CO)、体循环血管阻力(SVR)等指数变化。结果经NIPPV治疗后,患者PaO₂、SaO₂较通气前显著增高(P＜0.01),HR下降(P＜0.05),MAP、CI、CO、SVR较通气前无显著改变(P＞0.05)。结论NIPPV能提高脓毒症所致ALI/ARDS早期患者的SaO₂、PaO₂,同时对血流动力学没有不良影响。

Abstract:

Objective To investigate the effects of noninvasive positive ventilation（NIPPV） on hemodynamics of patients with acute lung injury/acute respiratory distress（ALI/ARDS） induced by sepsis.Methods Twenty nine patients with ALI/ARDS induced by sepsis were included in the study.The blood gas analysis（SaO₂,PaO₂ and PaCO₂）,HR,and hemodynamics（MAP,CI,CO,SVR） measured by noninvasive heart function before and 2-4 hours,24 hours after NIPPV,and withdrawing of NIPPV were recorded and analyzed.Results The index（PaO₂,SaO₂） were increased（P＜0.01）,HR was improved（P＜0.05）after treatment of NIPPV;while there were no significant differences in hemodynamics（MAP,CI,CO,SVR） before and after treatment（P＞0.05）.Conclusion For patients with ALI/ARDS induced by sepsis in the early stage,NIPPV treatment can improve the arterial oxygen saturation（SaO₂） and arterial partial pressure of oxygen（PaO₂）,and has no significant side effects on circulation dynamics.