肺开放对外科脓毒症引起的ARDS患者氧输送的影响

李颖¹ 冯永文¹ 李明利¹ 吴明¹ 曾晶晶¹ 陆柳明¹ 崔曼丽¹
深圳市第二人民医院

Abstract  Objective: To investigate the effects of open lung strategy on oxygen delivery in patients with Acute Respiratory Distress Syndrome (ARDS) induced by surgical severe sepsis. Methods：Thirty patients with ARDS caused by surgical severe sepsis from January of 2009 to January of 2010 were enrolled in the study. They were initially treated by Early Goal-Directed Treatment (EGDT) after admission, then, were randomly subdivided into two groups: a control group and a therapy group (fifteen patients per group). The control group was treated with low tidal volume lung protective ventilation；while the therapy group were treated with low tidal volume lung protective ventilation combined with lung open strategy. Pulse Index Continuous Cardiac Output (PiCCo) was used to monitor hemodynamic changes in these two groups to evaluate the effects of open lung strategy on the respiratory mechanics and oxygen delivery in patients with ARDS induced by surgical severe sepsis. Results: (1) After the opening lung for patients in therapy group, the Peak Inspiratory Pressure (PIP) and Platform Pressure (Pplat) decreased, while the Static Lung Compliance (Cst) increased. And these measurements in both groups were significant difference after the 1 hour (h), 2 h, 4h and 6h at the same time points. (2) Significant difference on oxygen delivery in patients were also detected in 1h, 2h and 4h after the opening lung, and no significant difference between them after 6h (P> 0.05).Conclusions: The open lung strategy could recruit the collapsed alveolus in patients with ARDS caused by surgical severe sepsis. It could significantly improve lung compliance and increase oxygen delivery. The open lung interval is preferred not more than 6 hours with ARDS induced by surgical severe sepsis．