高频通气治疗胸部创伤合并急性呼吸窘迫综合征的临床研究

Clinical study of high frequency ventilation in chest trauma with acute respiratory distress syndrome

目的探讨高频通气(highfrequencyventilation,HFV)治疗胸部创伤合并急性呼吸窘迫综合征(acuterespiratorydistresssyndrome,ARDS)的临床应用价值。方法对该院1999年6月以来胸部创伤合并ARDS的患者随机分为治疗组与对照组,治疗组30例应用HFV,对照组26例应用常频机械通气(conventionalmechanicalventilation,CMV),通过监测氧合指数OI(PaO2/FiO2)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)等参数,评估HFV治疗重症胸部创伤合并ARDS的治疗效果及临床应用价值。结果治疗组应用HFV治疗前后比较,OI、PaO2在应用HFV4h后均显著提高(P<0.01)。两组患者对比,OI在治疗前及治疗2h后差异无显著性(P>0.05),在治疗4、8、16、24h及48h后差异有显著性(P<0.05);PaCO2在治疗前及治疗2h后差异无显著性(P>0.05),在治疗4h后差异有显著性(P<0.05)、8h后均有显著差异(P<0.01)。HFV组病死率为40.0%。结论HFV能够促进胸部创伤合并ARDS患者的肺脏通气,有效改善氧合、纠正低氧血症;同CMV对比,HFV改善氧合、提高OI的疗效更加显著,在应用HFV4h后可引起CO2的轻度潴留;HFV有助于胸部创伤合并ARDS患者的急救,值得临床推广应用、深入研究。

[Objective] To investigate the clinical value of high frequency ventilation （HFV） for chest-injured with acute respiratory distress syndrome（ARDS）. [Methods] Since June 1999, we have reviewed clinical data of all patients of chest injury with ARDS. Randomized controlled trials comparing HFV and conventional mechanical ventilation （CMV） in patients of chest injury with ARDS. The data extracted included patient OI（PaO22/FiO2）, PaO2, PaCO2, et al. All data were recorded at regular intervals in all patients. According to these data, we assessed the clinical outcomes and value of HFV for chest injury with ARDS. [Results] A total of 56 patients met study criteria. 30 patients use of HFV. There was an increase in OI and PaO2 （P 〈0.01） at 4 hours after institution of HFV. Overall analysis of the two trials, as compared to CMV in 26 patients, showed that there was an increase in OI （P 〈0.05） at 4 hours and 8 hours after institution of HFV, in PaCO2 （P 〈0.05） at 4 hours and （P 〈0.01） at 8 hours after institution of HFV. The mortality rate was 40.0% in the group with HFV. [Conclusions] Therapy with HFV produced a significant improvement in pulmonary oxygenation and improved hypoxemia. Compared to CMV, this therapy was much remarkable for the management of ARDS among chest-injured trauma patients. But this therapy would result in little increase in PaCO2. This therapy may be advantageous rescue method for the management of ARDS among chest-injured trauma patients. Ventilation with HFV may be worthy of extending clinical application and further studies.