允许性高碳酸血症通气法治疗急性呼吸窘迫综合征的临床研究

Permissive hypercapnia ventilation in the treatment of respiratory distress syndrome

目的探讨允许性高碳酸血症通气法(PHV)治疗急性呼吸窘迫综合征(ARDS)中的价值。方法1996年3月～2005年12月收住PICU,符合1994年欧美制订的ARDS诊断标准确诊为ARDS的患儿27例,分为治疗组12例。采用PHV通气,维持PaCO_2在45～55 mm Hg(1 mm Hg= 0.133 kPa)之间;对照组15例,常规通气方式。监测机械通气24、48 h的呼吸机参数、血气值和氧合指数(PaO_2/FiO_2,OI),比较两组机械通气时间、并发症、死亡例数。结果(1)治疗24、48h后,治疗组PIP、PEEP、MAP值显著低于对照组(P<0.05);OI、pH及PaO_2差异无显著性(P>0.05).治疗组Pa- CO_2较对照组显著高(P<0.01)。(2)治疗组机械通气时间较对照组显著减少(P<0.01);对照组5例发生气漏较治疗组差异有显著性(P<0.05);两组病死率差异无显著性(25%比26.7%,P>0.05)。结论PIV法治疗ARDS较传统通气方式可减低并发症、缩短通气时间,病死率无明显降低。

Objective To explore the benefit of permissive hypercapnia ventilation （PHV） on treatment of acute respiratory distress syndrome （ARDS）. Methods From March 1996 to December 2005, 27 patients were enrolled in this study. ARDS was diagnosed according to the 1994 AECC definition. Twelne patients received PHV by maintaining the PaCO2 at 45 to 55 mm Hg as treatment group （T）, 15 patients received conventional ventilation as controls （C）. Variables included ventilation setting, PaO2/FiO2 and blood gas, mortality, ventilation duration and incidence of complication. Results （ 1 ） At 24 h and 48 h of ventilation, levels of peak inspiratory pressure （PIP）, positive end-expiratory pressure （PEEP） and mean airway pressure （MAP） in T group were significantly lower than these in controls （P 〈 0.01）. PaO2/FiO2 （OI）, pH and PaO2 both didn＇t differ between two groups. PaCO2 both significantly differed between two groups. （2） Ventilation time in T group was shortened （8 ± 2 days vs 11 ± 3 days, P〈 0.01） and there was no difference in mortality between the groups （26.5 % vs 25 %, P = 0.34）. Five patients in C group developed pneumothorax and none in T group （P 〈 0.05）. Conclusion Although no improvement in the survival, PHV was associated with reduction in complication and mechanical ventilation duration.