体外循环术后ARDS的肺保护性通气治疗

Mechanical ventilation treatment on acute respiratory distress syndrome in operations by cardiopulmonary bypass

目的:探讨体外循环术后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的早期诊断和呼吸机"肺保护性"通气治疗。方法:手术病人分成传统机械呼吸+终末正压通气(posi-tive end expiratory pressure,PEEP)组(13例)和呼吸机"肺保护性"通气组(21例)。回顾分析两组病人体外循环术后ARDS的诊治过程。结果:传统机械通气+PEEP组带机时间(7.2±3.6)d,死亡8例,病死率61.5%;呼吸机"肺保护性"通气组带机时间(4.8±2.1)d,死亡5例,病死率23.8%,两组比较差异有统计学意义(P<0.05)。结论:早期诊断和及时治疗是该病治疗的关键,呼吸机"肺保护性"通气治疗ARDS比传统机械呼吸+PEEP效果更优越,同时积极处理原发损伤和预防各种并发症也很重要。

Objective To explore the early diagnosis of acute respiratory distress syndrome（ARDS）and the mechanical ventilation treatment in operations of cardiopulmonary bypass.Methods Thirty-four patients with acute respiratory distress syndrome were divided into the traditional ventilation strategy plus positive end expiratory pressure（PEEP）group（n=13）and the protective ventilation strategy group（n=21）,and their diagnosis and treatment were reviewed.Results The average ventilator-carrying time in the protective ventilation strategy group and the traditional ventilation strategy plus PEEP group was（4.8±2.1）and（7.2±3.6）days,and the mortality was 23.8% and 61.5% respectively.There was statistical significance in the 2 groups（P〈0.05）.Conclusion The key to ARDS is the early diagnosis and ventilation strategy.Protective ventilation strategy in treating ARDS is more effective than the traditional ventilation strategy plus PEEP,and it can obviously shorten the ventilator-carrying time and reduce the mortality of ARDS.