肺内源性和肺外源性呼吸衰竭机械通气的临床对比研究

Clinical comparative study of mechanical ventilation on pulmonary-interior and exterior respiratory failure

目的探讨肺内源性和肺外源性呼吸衰竭机械通气时的肺保护性策略。方法通过25例呼吸衰竭中12例肺内源性和13例肺外源性机械通气临床资料的回顾性分析,对比研究两组呼吸力学差异时对通气模式选择、参数设置和调节的影响,以及肺保护的实施方法。结果在两组APACHE-Ⅱ评分、平均年龄和Vt设置无差异的条件(P>005)下,肺内源性组PEEP/CPAP、PSV、f的需设值均明显高于肺外源性组(P<001)。肺内源性组Pplat、PIP、Raw的监测结果大于肺外源性组,而Crs小于肺外源性组(P<001)。肺内源性组417%和肺外源性组154%因MOF而死亡(APACHE-Ⅱ评分均>20分),组间比较有显著差异(P<001)。结论肺内源性和肺外源性呼吸衰竭机械通气时,实施肺保护的方法不同。前者应首选压力预置通气模式,后者可首选容量预置通气模式。以设置中、小Vt为原则,按个体化的通气需求而设置f和加用恰当的PSV、CPAP/PEEP对减少VILI、病死率可能有益。

Objective The purpose was to explore the lung protective ventilatory strategies about pulmonary-interior and exterior respiratory failure.Methods We retrospectively studied the clinical data of 25 respiratory failure cases, including 12 interior cases and 13 exterior cases.Moreover,we also analyzed the effect of difference in respiratory mechanics on the pattern fabrication,parameters layout and regulation as well as the lung protection method.Results On the condition that there was no difference in APACHE-Ⅱ grade,mean age,and Vt between groups( P >0 05),whereas the results of Crs was significantly lower than those in exterior group (P<0 01).The mortality rates were accounted for 41 7% and 15 4%,respectively, which had markedy statistical difference in interior and exterior group(P<0 01),and they all died of MOF (APACHE-Ⅱ grade>).Conclusions We should carry out different lung protection method in mechanical ventilation of pulmonary-interior and exterior respiratory failure.The former firstly selects pre-setting pressure mechanical ventilation and the latter firstly selects pre-setting volume mechanical ventilation.In conclusion,there is a principle that setting middle or low Vt,appropriate frequency and adding PSV,CPAP/PEEP according to individual ventilation demand,which is helpful to reducing VILI,morbidity and mortality. [