老年急性脑卒中患者合并呼吸衰竭的机械通气治疗

Treatment of mechanical ventilation in the aged acute cerebral stroke with respiratory failure

目的探讨肺保护性通气策略(LPVS)在老年急性脑卒中合并呼吸衰竭患者救治中的意义。方法通过对55例老年急性脑卒中合并呼吸衰竭患者实施机械通气的临床资料进行回顾性分析,对比观察常规机械通气(n=27)和LPVS(n=28)对其动脉血气、呼吸力学、血流动力学、机械通气并发症、颅内压和病死率等的影响。结果LPVS和常规机械通气均能明显改善患者的动脉血气指标,两组差异无统计学意义(P>0.05);LPVS对改善呼吸力学、血流动力学和降低机械通气并发症、病死率等均优于常规机械通气,两组差异有统计学意义(P<0.05);LPVS对老年急性脑卒中患者的颅内压无不良影响。结论老年急性脑卒中合并呼吸衰竭患者机械通气可采用LPVS,设置小潮气量、限制经肺压和加用呼气末正压。同时应加强专科治疗,积极纠正循环和代谢功能障碍。

Objective To explore the meaning of lung protective ventilatory strategies in the aged acute cerebral stroke with respiratory failure, Methods We retrospectively study the clinical data about 55 cases of ventilatory strategies in the aged acute cerebral stroke with respiratory failure and compare the effect of routine（ n = 27） or protective （ n = 28） mechanical ventilation on their arterial blood gas, respiratory mechanics, haematic dynamics, ventilatory complication, encephalic pressure and mortality. Results The protective and routine mechanical ventilation have significant effect on improving the marker of arterial blood gas analysis （ P 〉 0.05 ）. The former is more efficient in improving the respiratory mechanics and haematic dynamics and decreasing ventilatory complication and mortality than the latter （ P 〈 0.05）. Lung protective strategies has no had effect on encephalic pressure. Conclusions The hmg protective ventilatory strategies should be applied to the aged acute cerebral stroke with respiratory failure, which include setting low tide volume, restricting via- pulmanory pressure and adding positive end- expiratory pressure. Synchronously, it is very important for positively strengthening faculty treats and correcting circulation and metabolism malfunction.