呼气末正压递增法在心脏瓣膜术后肺不张患者中应用的效果观察

doi:10.3969/j.issn.1006-9143.2019.01.008

天津护理

呼气末正压递增法在心脏瓣膜术后肺不张患者中应用的效果观察

刘彦飞¹ 薛杨² 陈韵芳¹

（1.天津市第三中心医院，天津 300170；2.四川大学华西医院）

收稿日期:2018-03-11 修回日期:2018-11-01 出版日期:2019-02-28 发布日期:2019-05-06

Observation of the effect of PEEP increasing therapy on atelectasis in patients after cardiac valve operation

LIU Yanfei¹, XUE Yang², CHEN Yunfang¹

(1.The Third Central Hospital of Tianjin, Tianjin 300170; 2.West China Hospital of Sichuan University)

Received:2018-03-11 Revised:2018-11-01 Online:2019-02-28 Published:2019-05-06

摘要/Abstract

摘要： 目的:探讨呼气末正压（positive end-expiratory pressure，PEEP）递增法改善心脏瓣膜术后肺不张患者肺复张呼吸功能的效果。方法：在基础PEEP的基础上每隔30 s增加5 cmH2O最高到30 cmH2O。然后每隔30 s递减5 cm H2O直至恢复原来的PEEP。结果：肺复张前、PEEP=30 cmH2O、肺复张2 h后患者SpO2、HR、SAP、CVP比较差异有统计学意义，进一步两两比较显示在PEEP=30 cmH2O 时 SpO2高于复张前和复张2 h后（P<0.05），复张2 h后SpO2高于复张前（P<0.01）。PEEP=30 cmH2O 时 CVP高于肺复张前和肺复张2 h后（P<0.01）， HR和SAP低于肺复张前、肺复张2 h后；而肺复张前和肺复张2 h后比较无统计学意义（P＞0.05）。肺复张前和肺复张2 h后及潮气量、肺顺应性和氧合指数的比较差异有统计学意义（P＜0.05），肺复张前和肺复张2 h后气道阻力比较差异无统计学意义（P＞0.05）。结论：PEEP递增法在心脏瓣膜术后肺不张的应用能够改善患者的肺部通气，安全的使患者肺复张，保证患者在呼吸机低辅助条件下顺利通过自主呼吸试验，尽早脱机。

关键词: 肺复张, 呼气末正压, 护理, 心脏外科手术

Abstract: Objective: To investigate the effect of PEEP increasing method on pulmonary recruitment in patients with atelectasis after cardiac valve surgery. Methods: On the basis of PEEP, 5cmH2O was increased to 30cmH2O at the highest every 30 seconds. Then, every 30 s, the PEEP decreased by 5cmH2O until the original PEEP was restored. Results: There were statistically significant differences in SpO2, HR, SAP and CVP of the patients before intervention, PEEP=30 cmH2O and 2 h after pulmonary recruitment. Further comparison showed that SpO2 was significantly higher than before and 2 h after pulmonary recruitment when PEEP was 30 cmH2O (P<0.05), and SpO2 was significantly higher than that of at 2 h after pulmonary recruitment(P<0.01). When PEEP was 30 cmH2O, CVP increased significantly (P<0.01), while HR and SAP decreased significantly. However, there was no statistically significant difference between before and 2 h after pulmonary recruitment. There were statistically significant differences in tidal air volume, lung compliance and oxygenation index between before an after pulmonary recruitment(P<0.05), and no statistically significant differences in airway resistance(P>0.05). Conclusion: The application of PEEP incremental method can improve pulmonary ventilation in atelectasis patients after cardiac valve surgery, safely make pulmonary revascularization, ensure successfully pass the independent breathing test under the low auxiliary conditions of the ventilator, and get off the machine as soon as possible.

Key words: Pulmonary recruitment, Positive end-expiratory pressure (PEEP), Cardiac operation, Nursing

刘彦飞薛杨陈韵芳. 呼气末正压递增法在心脏瓣膜术后肺不张患者中应用的效果观察[J]. 天津护理, DOI: 10.3969/j.issn.1006-9143.2019.01.008.

LIU Yanfei, XUE Yang, CHEN Yunfang. Observation of the effect of PEEP increasing therapy on atelectasis in patients after cardiac valve operation[J]. , DOI: 10.3969/j.issn.1006-9143.2019.01.008.

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呼气末正压递增法在心脏瓣膜术后肺不张患者中应用的效果观察

Observation of the effect of PEEP increasing therapy on atelectasis in patients after cardiac valve operation

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