摘要
目的观察肺保护性通气对急性肺损伤(ALI)患者的影响。方法40例ALI患者均在常规治疗的基础上予以机械通气(SIMV模式),随机分为传统通气组和肺保护性通气组,每组各20例。记录ALI患者机械通气后即刻2、h6、h2、4 h及48 h的动脉血气结果、氧合指数(PaO2/FiO2)、气道平台压(PPlat)、吸入峰值压(PPeak)、呼吸系统顺应性(Crs)、呼气末正压(PEEP)、内源性PEEP(PEEPi)及28 d死亡率。结果肺保护性通气组在机械通气48 h后PaCO2明显增加[(48.6±3.5)mm Hg比(37.7±3.1)mm Hg,P<0.05],同时伴pH值明显下降[(7.25±0.16)比(7.33±0.23),P<0.05];两组患者在机械通气后PaO2/FiO2均有改善,且肺保护性通气组在通气后6 h明显优于传统通气组[(156±12)比(146±15),P<0.05];传统通气组的PPlat和PPeak均明显高于肺保护性通气组[通气24 h后分别为:(22.1±1.3)cm H2O比(16.6±2.1)cm H2O,(28.3±3.7)cm H2O比(24.6±2.1)cm H2O;通气48 h后分别为:(24.4±1.6)cm H2O比(16.5±1.7)cm H2O,(31.7±3.5)cm H2O比(25.3±2.3)cm H2O;P均<0.05];肺保护性通气组的PEEPi略高于传统通气组,差异无统计学意义(P>0.05);肺保护性通气组的28 d死亡率小于传统通气组(10%比20%),差异无统计学意义(P>0.05)。结论肺保护性通气可改善ALI患者的氧合而不增加死亡率。
Objective To observe the effects of lung protective ventilation in the patients with acute lung injury （ALI）.Methods Forty patients suffering from ALI were mechanical ventilated （SIMV mode） and were randomized to receive traditional ventilation as control group or lung protective ventilation as lung protective ventilation goup, respectively （ n = 20, respectively）. Results of arterial blood gas, index of oxygenation （PaO2/FiO2 ）, airway plateau pressure （ PPlat）, inspiration peak pressure （PPeak）, compliance of respiration system （Crs）, positive end-expiration pressure （PEEP）, intrinsic end-expiration pressure （PEEPi） and mortahty of 28 days were recorded. Results PaCO2 of the patients in the lung protective ventilation group were obviously increased after mechanical ventilated for 48 h than baseline [ （48.6 ± 3.5） mm Hg vs （37.7 ± 3.1 ） mm Hg, P 〈 0.05） ] and that of the control group （ P 〈0.05）.Meanwhile,the pH of the lung protective ventilation group decreased obviously after ventilated 48 h [ （7.25 ± 0.16 ） vs （ 7.33 ± 0.23 ）, P 〈 0.05 ]. PaO2/FiO2 of all patients were improved,but the improvement of the lung protective ventilation group were more significant than those in the control group after ventilated for 6 h （ 156 ± 12 vs 146 ± 15, P 〈 0.05±. PPlat and PPeak of the control group were significantly higher than those in the lung protective ventilation group [ after ventilation 24 h： （22.1 ± 1.3）cm H2O vs （16.6± 2.1）cm H2O, （28.3 ± 3.7）cm H2O vs （24.6± 2.1）cm H2O, respectively; after ventilation48 h： （24.4 ± 1.6） cmH2O vs （16.5 ± 1.7）cm H2O, （31.7 ± 3.5）cm H2O vs （25.3 ± 2.3） cm H2O, respectively,all P 〈 0.05] .Although PEEPi were higher in the lung protective ventilation group, the difference was not significant （ P 〉 0.05）. There was no significant difference in mortality of 28 days between the lung protective vemilation group, and the control group （ 10% vs 20%, P 〉 0.05）. Conclusion Lung protective ventilation can improve oxygenation and do not increase mortality of ALI.
出处
《中国呼吸与危重监护杂志》
CAS
2006年第4期267-270,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
肺保护性通气
急性肺损伤
Lung protective ventilation
Acute lung injury
