肺保护性通气在开胸手术后急性呼吸窘迫综合征患者中的应用

The Application of Lung-protective Strategies of Ventilation for Patients with Acute Respirator Distress Syndrome after Thoracic Operation

目的观察肺保护性通气(LPSV)对开胸手术后发生急性呼吸窘迫综合征(ARDS)患者的治疗效果。方法37例术前无其他合并症、手术顺利而术后发生ARDS的患者在常规治疗的基础上给予机械通气[同步间歇性指令呼吸(SIMV)+压力支持模式(PSV)+呼气末正压(PEEP)或双水平气道压通气(BiPAP)],并根据通气模式的不同分为常规通气组(CMV组,20例)和肺保护性通气组(LPSV组,17例),记录两组患者机械通气后24h的动脉血气分析结果、氧合指数(PaO2/FiO2)、气道平台压(Pplat)、吸入峰值压(PIP)、PEEP及机械通气时间、气压伤等指标的差异。结果LPSV组机械通气时间、气压伤发生率和病死率分别为7.3d、5.9%和29.4%,而CMV组为17.6d、15.0%和60.0%,两组比较差异有统计学意义(P<0.05);LPSV组的气道压,包括PIP和Pplat显著低于CMV组,差异有统计学意义(P=0.031,0.031)。两组患者的动脉血氧饱和度(SaO2)、pH、动脉血二氧化碳分压(PaCO2)和PaO2/FiO2差异无统计学意义(P>0.05)。结论LPSV可明显减少呼吸机相关性肺损伤,降低了病死率,是开胸手术后ARDS患者的一种有效通气方法。

Objective To evaluate the efficacy of lung-protective strategies of ventilation （LPSV） in acute respiratory distress syndrome （ARDS） patients after thoracic operation. Methods Thirty-seven ARDS patients without preoperative complications who had underwent thoracic surgery successfully were divided into the conventional mechanical ventilation group （CMV group, n = 20） and lung-protective strategies of ventilation group （LPSV group,n = 17）. Results of arterial blood gas, index of oxygenation （PaO2/FiO2）, airway plateau pressure （Pplat）, inspiration peak pressure （PIP）, PEEP, after ventilation treatment 24 h and mechanical ventilation time, pulmonary barotrauma and so on were observed. Results The mechanical ventilation time, pulmonary barotrauma and mortality of the LPSV group were 7.3d, 5.9% and 29. 4% respectively, which were significantly better than those in the CMV group（17.6d,15.0% and 60.0%, P〈0.05）. peak inflation pressure （PIP）,Pplat（plat pressure） in the LPSV group were significantly lower than those in the CMV group （P〈0. 05）. However, there were no significant differences including arterial oxygen saturation （SaO2）, pH, partial pressure of carbon dioxide in artery （PaCO2） and PaO2/FiO2 in two groups. Conclusion LPSV is more effective for the patients in the ARDS patients after thoracic operation compared to CMV, which can markedly reduce the ventilator-induced lung injuryand （VILI） and mortality.