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目的观察胸腔积液引流对机械通气的急性呼吸窘迫综合征(ARDS)患者氧合及呼吸力学的影响。方法选择2013年1月至2014年6月的在河南中医学院第一附属医院重症医学科住院的43例机械通气合并大量胸腔积液(≥500 ml)的ARDS患者,其中肺内源性组25例,肺外源性组18例。在超声引导下行胸腔积液引流术,术前及术后记录两组患者的氧合指数(Pa O2/Fi O2)、肺静态顺应性(Cstat)、平台压(Pplat)、气道峰压(Ppeak)。结果两组患者在胸腔积液引流术后呼吸力学参数改善,Cstat均高于术前(P均<0.05),而Pplat、Ppeak均低于术前(P均<0.05)。肺内源性组在胸腔积液引流术前后Pa O2/Fi O2变化无统计学差异(P>0.05),肺外源性组在胸腔积液引流术后Pa O2/Fi O2高于术前(P<0.05)。结论胸腔积液引流可改善机械通气合并大量胸腔积液ARDS患者的呼吸力学指标及肺外源性ARDS患者的氧合,但不改善肺内源性ARDS患者的氧合。
Objective To observe the effects of pleural fluid drainage on oxygenation and respiration mechanics in patients with mechanical ventilation of acute respiratory distress syndrome (ARDS). Methods From January 2013 to June 2014, 43 ARDS patients with mechanical ventilation and pleural effusion (≥500 ml) hospitalized in the Department of Critical Care Medicine of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine were enrolled. Among them, the endogenous lung group 25 Cases, lung extrinsic group of 18 cases. Pleural effusion drainage was performed under ultrasound guidance. PaO2 / Fi O2, Cstat, Pplat and peak airway pressure were recorded preoperatively and postoperatively Ppeak). Results Both groups had improved respiratory mechanics parameters after pleural effusion drainage. Cstat was higher than preoperative (P <0.05), while Pplat and Ppeak were lower than preoperative (P <0.05). There was no significant difference in PaO 2 / Fi O 2 before and after pleural effusion in pulmonary endometrial group (P> 0.05). PaO2 / Fi O2 in pleural effusion group was higher than that in preoperative (P <0.05). Conclusions Pleural effusion drainage can improve the respiratory mechanics index and the oxygenation of ARDS patients with mechanical ventilation and pleural effusion, but not improve the oxygenation of endogenous ARDS patients.