目的 探討新的氧合指數(shù)即結(jié)合了平均氣道壓( Paw) 的[ PaO2 / ( FiO2 ×Paw) ] 能否較傳統(tǒng)氧合指數(shù)( PaO2 /FiO2 ) 更準(zhǔn)確地反映急性呼吸窘迫綜合征( ARDS) 患者的肺內(nèi)分流( Qsp/Qt) 。方法 符合ARDS 診斷標(biāo)準(zhǔn)的患者12 例, 氣管插管呼吸機支持, 采用肺保護性通氣策略( 潮氣量6 mL/kg, 呼吸頻率16 次/min, FiO2 60% ) , 留置Swan-Ganz 導(dǎo)管, 采用低流速法測定準(zhǔn)靜態(tài)肺壓力-容積曲線, 確定低位轉(zhuǎn)折點壓力( Pinf) 。調(diào)整PEEP水平, 觀察血流動力學(xué)、呼吸力學(xué)的變化, 分別留取外周及肺動脈血行血氣分析, 計算Qsp/Qt 和PaO2 /FiO2。結(jié)果 遞增的呼氣末正壓( PEEP) 不足以顯著改變ARDS 患者的肺順應(yīng)性( Cst) 、PaO2 /FiO2 及PaO2 /( FiO2 ×Paw) ( P gt; 0. 05) 。遞增的PEEP 對Qsp/Qt 改變不明顯( P gt;0. 05) 。檢驗Qsp /Qt 與PaO2 /( FiO2 ×Paw) 及Qsp/Qt 與PaO2 /FiO2 的相關(guān)系數(shù), Δz =0. 571, 無顯著性差異( P gt;0. 05) 。影響ARDS 患者的Qsp/Qt 和PaO2 /FiO2 的參數(shù)不是Paw,而是Cst。結(jié)論 PaO2 / ( FiO2 ×Paw) 與PaO2 /FiO2 相比, 兩者對ARDS 患者肺內(nèi)分流的評估價值相當(dāng)。
引用本文： 劉長文,胡偉航,胡煒,陸駿,鄭永科,朱克毅,朱英,王劍榮. PaO2 / ( FiO2 ×Paw ) 對急性呼吸窘迫綜合征患者肺內(nèi)分流的評估價值. 中國呼吸與危重監(jiān)護雜志, 2010, 9(6): 560-563. doi: 復(fù)制
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| 4. | Meaghan M, Taylor RN, CRNP/ ACNP. ARDS Diagnosis and Management. Dimens Crit Care Nurs, 2005, 24: 197 -207. |
| 5. | Nirmalan M, Willard T, Columb MO, et al. Effect of changes in arterial-mixed venous oxygen content difference [ C( a-v) O2 ] on indices of pulmonary oxygen transfer in a model ARDS lung. Br J Anaesth, 2001, 86: 477 -485. |
| 6. | Hedwig M,Maurice L, Ginette D, et al. An animal modelof response and nonresponse to inhaled nitric oxide in endotoxin-induced lung injury. Chest, 2001, 120: 573-581. |
| 7. | Nunn JF. Applied respiratory physiology. 4 th ed. O ×ford UK:Butterworth-Heinemann, 1993. |
| 8. | 邱海波. Swan-Ganz 肺動脈導(dǎo)管不應(yīng)在重癥加強治療病房中常規(guī)應(yīng)用. 中華外科雜志, 2006, 44 : 1222 -1224 . |
| 9. | Scott HD, Willia DB, Kirby LZ, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med, 2006 , 354: 2213-2224. |
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| 11. | Villar J, Perez-Mendez L, Kacmarek RM. Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intensive Care Med, 1999 , 25 : 930 -935. |
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- 1. 陳成, 黃建安. 急性肺損傷/ 急性呼吸窘迫綜合征預(yù)后評估指標(biāo)研究進展. 中國呼吸與危重監(jiān)護雜志, 2008, 7 : 156-160.
- 2. Mohamad FE, Ghassan WJ. A new oxygenation index for reflecting intrapulmonary shunting in patients undergoing open-heart surgery.Chest, 2004, 125: 592 -596.
- 3. 中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會. 急性肺損傷/急性呼吸窘迫綜合征診斷和治療指南( 2006 ) . 中華急診醫(yī)學(xué)雜志, 2007, 12 : 343 -349.
- 4. Meaghan M, Taylor RN, CRNP/ ACNP. ARDS Diagnosis and Management. Dimens Crit Care Nurs, 2005, 24: 197 -207.
- 5. Nirmalan M, Willard T, Columb MO, et al. Effect of changes in arterial-mixed venous oxygen content difference [ C( a-v) O2 ] on indices of pulmonary oxygen transfer in a model ARDS lung. Br J Anaesth, 2001, 86: 477 -485.
- 6. Hedwig M,Maurice L, Ginette D, et al. An animal modelof response and nonresponse to inhaled nitric oxide in endotoxin-induced lung injury. Chest, 2001, 120: 573-581.
- 7. Nunn JF. Applied respiratory physiology. 4 th ed. O ×ford UK:Butterworth-Heinemann, 1993.
- 8. 邱海波. Swan-Ganz 肺動脈導(dǎo)管不應(yīng)在重癥加強治療病房中常規(guī)應(yīng)用. 中華外科雜志, 2006, 44 : 1222 -1224 .
- 9. Scott HD, Willia DB, Kirby LZ, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med, 2006 , 354: 2213-2224.
- 10. Gowda MS, Klocke RA. Variability of indices of hypoxemia in adult respiratory distress syndrome. Crit Care Med, 1997, 25 : 41 -45.
- 11. Villar J, Perez-Mendez L, Kacmarek RM. Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intensive Care Med, 1999 , 25 : 930 -935.
- 12. 侯靜靜, 朱蕾, 鈕善福, 等. 氧合指數(shù)的影響因素及其在急性肺損傷診斷中的作用. 中華急診醫(yī)學(xué)雜志, 2006 , 11: 971-974.
- 13. 李志強, 朱波, 王長友, 等. 高呼氣末正壓機械通氣策略在ARDS患者中應(yīng)用的系統(tǒng)評價. 中國呼吸與危重監(jiān)護雜志, 2009, 8 :279-283.