机械通气策略对脑弥漫性轴索损伤预后的影响

Effects of mechanical ventilation strategy on prognosis of diffuse axonal injury

目的探讨机械通气对脑弥漫性轴索损伤患者预后的影响。方法32例脑弥漫性轴索损伤(diffuse axonal injury,DAI)患者随机分为A组(对照组,n=17,男12例,女5例,平均年龄35.4岁,接受常规综合治疗)和B组(n=15,男11例,女4例,平均年龄34.6岁,年龄和性别分布与A组差异无统计学意义,除接受常规综合治疗外加机械通气)。比较两组治疗前后的GCS评分,生理指标(MBP、RR、HR),血气指标(pH、PaO_2、PaCO_2、SaO_2)和预后指标。结果治疗后GCS评分B组痊愈率明显高于A组;B组监测的生理指标及血气指标均有不同程度改善;B组生存率66.66%,高于A组47.06%(P<0.01);B组病死率33.33%,显著低于A组52.94% (P<0.01)。结论常规综合治疗加机械通气在目前缺乏对DAI特异性治疗方法的前提下,不失为治疗DAI的有效手段,对DAI的预后有一定改善。

Objective To investigate the effects of mechanical ventilation strategy on the prognosis of diffuse axonal injury(DAI).Methods Thirty-two DAI patients were randomly divided into 2 groups:Group A(n=17,control group, undergoing conventional comprehensive treatment)and sex-and aged-matched Group B(n=15,undergoing mechanical ventilation in addition of conventional comprehensive treatment),Glasgow coma score(GCS),physiological indexes[mean blood pressure,respiratory rate(RR),and heart rate(HR)],and blood gas indexes[pH,partial pressure of oxygen (PaO_2),partial pressure of carbon dioxide(PaCO_2),and arterial oxygen saturation(SaO_2)],and survival rate were observed.Results In Group B the HR and RR levels after treatment were(84.00±12.18)bpm and(21.00±4.24)min_(-1), both significantly lower than those before the treatment[(128.00±12.00)bpm and(34.00±6.16)min_(-1)respectively, P<0.01 and P<0.05];and the PaO_2 and SaO_2 after the treatment were(10.02±0.92)kpa and(92.18±5.26)% respectively,both significantly higher than those before treatment[(6.84±0.62)kpa and(72.62±6.32)% respective4ly, both P<0.01],The survival rate of Group B was 66.66%,significantly higher than that of Group A(47.06%,P<0.01). Conclusion Conventional comprehensive treatment combined with mechanical ventilation improves the prognosis of DAI.